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Observational Study
. 2025 Mar 17;48(1):305.
doi: 10.1007/s10143-025-03441-0.

Evaluation of clinical outcome and predictive factors for thromboembolism or hemorrhagic complications in patients treated for chronic subdural hematoma. A prospective observational study

Alba Scerrati  1   2 , Giorgio Mantovani  1   2 , Michele Alessandro Cavallo  1   2 , Maria Elena Flacco  3 , Pietro Zangrossi  1   2 , Silvia Eichner  1   2 , Luca Ricciardi  4 , Antonella Mangraviti  4 , Antonino Raco  4 , Tamara Ius  5 , Daniele Piccolo  5 , Oriela Rustemi  6 , Fabio Raneri  6 , Carmelo Lucio Sturiale  7 , Alberto Benato  8 , Giovanni Pennisi  8 , Francesco Signorelli  8 , Gianluca Trevisi  9 , Donato Carlo Zotta  9 , Giorgio Lofrese  10 , Lorenzo Mongardi  10 , Paul Roblot  11 , Nicola Montemurro  12 , Rosario Maugeri  13 , Mariachiara Sensi  14 , Pasquale De Bonis  1   2
Affiliations
Observational Study

Evaluation of clinical outcome and predictive factors for thromboembolism or hemorrhagic complications in patients treated for chronic subdural hematoma. A prospective observational study

Alba Scerrati et al. Neurosurg Rev. .

Abstract

The impact of anticoagulant and antiplatelet medications on clinical outcome and risk of complications is uncertain in chronic subdural hematoma (CSDH) patients. Currently, evidence-based guidelines and specific neurosurgical scores lacks. CHA₂DS₂-VASc and HAS-BLED scores have been proven to help predicting complications in the perioperative period of non-cardiac surgeries. We performed a multicenter prospective observational trial to evaluate the clinical outcomes and complications of CSDH patient undergoing surgery, comparing patients taking anticoagulant/antiplatelet (AAPT) and not (NT). Additionally, we investigated the role of CHA₂DS₂-VASc and HAS-BLED scores in predicting thromboembolic events or hemorrhages. No associations have been found between AAPT and clinical outcomes of patients. Emergency surgery was not a significant factor in improving outcomes. Post-operative hemorrhages were more frequent in the AAPT group, but none required a second surgery. A significant higher risk of of new bleedings was found in the ASA group with discontinuation ≤ 5 days. A higher HAS-BLED score was not associated with a worse clinical outcome. A 1-point increase in CHA₂DS₂-VASc was associated with a lower probability of favorable outcomes at 1 month. 90% of AAPT and 44% of NT patients were at moderate-high risk of thromboembolic events based on CHA₂DS₂-VASc score, with no difference in incidence between groups. The use of AAPT does not influence outcomes, complication rates, or recurrence in patients undergoing surgery for CSDH. Scores such as CHA₂DS₂-VASc or HAS-BLED could aid in stratifying bleeding and thromboembolic risks and in the management of these drugs in the perioperative period.

Keywords: Anticoagulant; Antiplatelet; CHA₂DS₂-VASc; Chronic subdural hematoma; HAS-BLED; Hemorrhagic complications; Thromboembolic complications.

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Conflict of interest statement

Declarations. Ethical statement: IRB approval was not required in our institutions for systematic review papers. Ethics and consent to participate: Not applicable. Disclosure: All authors have read and approved the submitted manuscript. The manuscript has not been submitted nor published elsewhere in whole or in part. The authors report no conflict of interest nor financial interest. Clinical trial number: not applicable. Data sharing: The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests: The authors declare no competing interests.

References

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