Impact of antithrombotic therapy on surgical treatment in patients with chronic subdural hematoma

Amano, Toshiyuki; Matsuo, Seiichiro; Miyamatsu, Yuichiro; Yamashita, Sojiro; Nakamizo, Akira

doi:10.1016/j.jocn.2020.01.076

Cited by 8 publications

(2 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Imaging Of Csdhmentioning

confidence: 99%

“…However, decisions surrounding the discontinuation or reversal (and the optimal time for resumption) of any anticoagulant and antiplatelet medications can be challenging and are frequently made on a patient-specific basis with consideration given to the primary indications for the medications, the hematoma size, and the presenting neurological status of the patient. [40][41][42][43] Several adjunctive medical treatments have been investigated with varying degrees of success including statins, steroids, and tranexamic acid. 15,16,[44][45][46] Jiang et al, 15 in a randomized controlled trial (RCT) of atorvastatin therapy in 196 patients with nonoperative cSDH with mild symptoms, reported that after 8 weeks, patients in the atorvastatin group had a better hematoma volume reduction, a better neurological outcome, and a lower rate of surgical bailout.…”

Section: Medical Managementmentioning

confidence: 99%

See 1 more Smart Citation

ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma

Kan,

Fiorella,

Dabus

et al. 2024

Stroke

View full text Add to dashboard Cite

ARISE (Aneurysm/AVM/cSDH Roundtable Discussion With Industry and Stroke Experts) organized a one-and-a-half day meeting and workshop and brought together representatives from academia, industry, and government to discuss the most promising approaches to improve outcomes for patients with chronic subdural hematoma (cSDH). The emerging role of middle meningeal artery embolization in clinical practice and the design of current and potential future trials were the primary focuses of discussion. Existing evidence for imaging, indications, agents, and techniques was reviewed, and areas of priority for study and key questions surrounding the development of new and existing treatments for cSDH were identified. Multiple randomized, controlled trials have met their primary efficacy end points, providing high-level evidence that middle meningeal artery embolization is a potent adjunctive therapy to the standard (surgical and nonsurgical) management of neurologically stable cSDH patients in terms of reducing rates of disease recurrence. Pooled data analyses following the formal conclusion and publication of these trials will form a robust foundation upon which guidelines can be strengthened for cSDH treatment modalities and optimal patient selection, as well as delineate future lines of investigation.

show abstract

Section: Imaging Of Csdhmentioning

confidence: 99%

Section: Medical Managementmentioning

confidence: 99%

ARISE I Consensus Statement on the Management of Chronic Subdural Hematoma

Kan,

Fiorella,

Dabus

et al. 2024

Stroke

View full text Add to dashboard Cite

show abstract

Impact of Early Resumption of Oral Anticoagulation on Recurrence After Surgery for Chronic Subdural Hematoma in Patients With Atrial Fibrillation: A Target Trial Emulation

Anno,

Fukasawa,

Shinozaki

et al. 2024

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

PurposeClinicians treating patients with atrial fibrillation (AF) on oral anticoagulants who undergo surgery for chronic subdural hematoma (CSDH) face a dilemma: while early postoperative resumption of anticoagulation is necessary to prevent embolism, it may increase the risk of CSDH recurrence. To date, however, no study has evaluated this question while adequately addressing common biases in observational studies. Here, we assessed this issue using target trial emulation framework.MethodsWe identified patients undergoing initial CSDH surgery who had received anticoagulation for AF preoperatively from two hospital‐based administrative databases (2014–2022). We compared two treatment strategies: resumption of anticoagulation within 14 days postoperatively versus no resumption during this period. Using a three‐step method of cloning, censoring, and weighting, we estimated the risk of CSDH recurrence, along with the risk ratio and risk difference at postoperative day 90.Results291 CSDH patients with AF were eligible, of whom 29 (10.0%) underwent CSDH reoperation. The weighted estimated 90‐day reoperation risk was 11.7% (95% confidence interval [CI], 6.0 to 14.3) for resuming anticoagulation within 14 days postoperatively and 9.4% (95% CI, 4.1 to 12.8) for not resuming within 14 days, corresponding to a risk ratio of 1.20 (95% CI, 0.67 to 2.36) and risk difference of 1.9% (95% CI, −4.0 to 6.6).Conclusions90‐day risk of CSDH recurrence may not differ between early and non‐early resumption of anticoagulation, although early resumption could modestly accelerate recurrence. Allowing for the imprecision of the estimates, these findings provide important insights for clinical decision‐making regarding anticoagulation resumption.

show abstract