Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma

Nathan, Santhosh; Goodarzi, Zahra; Jetté, Nathalie; Gallagher, Clare; Holroyd‐Leduc, Jayna

doi:10.1212/wnl.0000000000003918

Cited by 78 publications

(57 citation statements)

References 30 publications

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“…Current clinical guidelines on perioperative antithrombotic use emphasize an individual risk assessment with no clear guidance on the optimal timing of recommencing antithrombotic drugs. 5 An international survey of perioperative acetylsalicylic acid use in CSDH patients 6 confirms the significant variation in clinical practice shown in previous systematic reviews 2,8 and in our analysis. One retrospective cohort study compared outcomes in those who restarted on their antithrombotic drugs to those who did not.…”

Section: Discussionsupporting

confidence: 87%

“…These inconsistencies may stem from the differing study design of CSDH studies. 2,7,8,12 In our secondary analysis of this large cohort, we found no discernible difference in recurrence risk among those on previous antithrombotic drugs. A longer washout period of antiplatelet before an operation did not provide observable benefits.…”

Section: Discussionmentioning

confidence: 46%

“…6 Inconsistent conclusions were reached in several systematic reviews that evaluated hematoma recurrence risk in CSDH patients on antithrombotic drugs after surgical drainage. 2,7,8 Importantly, few studies have investigated the risk of thromboembolic events in patients with CSDH. 2,8 These uncertainties make clinical decision about antithrombotic drugs difficult.…”

Section: Introductionmentioning

confidence: 99%

“…2,7,8 Importantly, few studies have investigated the risk of thromboembolic events in patients with CSDH. 2,8 These uncertainties make clinical decision about antithrombotic drugs difficult.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage

Poon

Rea

Kolias

et al. 2021

Journal of Neurotrauma

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We aim to describe the outcomes after chronic subdural hematoma drainage (CSDH) management in a large cohort of patients on antithrombotic drugs, either antiplatelets or anticoagulants, at presentation and to inform clinical decision making on the timing of surgery and recommencement of these drugs. We used data from a previous UK-based multi-center, prospective cohort study. Outcomes included recurrence within 60 days, functional outcome at discharge, and thromboembolic event during hospital stay. We performed Cox regression on recurrence and multiple logistic regression on functional outcome. There were 817 patients included in the analysis, of which 353 (43.2%) were on an antithrombotic drug at presentation. We observed a gradual reduction in risk of recurrence for patients during the 6 weeks post-CSDH surgery. Neither antiplatelet nor anticoagulant drug use influenced risk of CSDH recurrence (hazard ratio, 0.93; 95% confidence interval [CI], 0.58-1.48; p = 0.76) or persistent/worse functional impairment (odds ratio, 1.08; 95% CI, 0.76-1.55; p = 0.66). Delaying surgery after cessation of antiplatelet drug did not affect risk of bleed recurrence. There were 15 in-hospital thromboembolic events recorded. Events were more common in the group pre-treated with antithrombotic drugs (3.3%) compared to the non-antithrombotic group (0.9%). Patients on an antithrombotic drug pre-operatively were at higher risk of thromboembolic events with no excess risk of bleed recurrence or worse functional outcome after CSDH drainage. The data did not support delaying surgery in patients on antithrombotic therapy. In the absence of a randomized controlled trial, early surgery and early antithrombotic recommencement should be considered in those at high risk of thromboembolic events.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 46%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage

Poon

Rea

Kolias

et al. 2021

Journal of Neurotrauma

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“…Antiplatelet drugs did not increase the CSDH recurrence rate following BHD. Similarly, a recent systematic study showed that anticoagulant drugs increased re-bleeding on the operation side of CSDH, but antiplatelet therapy did not [40]. However, this result is controversial as in other studies, antiplatelets or anticoagulants were not associated with CSDH recurrence [16,36,41].…”

Section: Discussionmentioning

confidence: 92%

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Chen

Wang

et al. 2020

BMC Neurol

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Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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Acute and chronic subdural hematoma

Peruski¹,

Selim²

2022

Pathy's Principles and Practice of Geriatric Medicine

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Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma

Abstract: Anticoagulant medication was associated with increased rebleeding risk in older adults with cSDH. However, antiplatelet medication was not associated with increased risk of rebleeding.

Cited by 78 publications

References 30 publications

Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage

Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Acute and chronic subdural hematoma

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