Impact of time to resumption of antithrombotic therapy on outcomes after surgical evacuation of chronic subdural hematoma: A multicenter cohort study

Zhang, John J.Y.; Aw, Natalie M.Y.; Tan, Choo Heng; Lee, Keng Siang; Chen, Vanessa H.E.; Wang, Shilin; Dinesh, Nivedh; Foo, Aaron Song Chuan; Yang, Ming; Goh, Chun Peng; Bolem, Nagarjun; Quah, Boon Leong; Sun, Ira Siyang; Ng, Zhi Xu; Teo, Kejia; Pang, Boon Chuan; Yang, Eugene Weiren; Lwin, Sein; Low, Shiong Wen; Yeo, Tseng Tsai; Santarius, Thomas; Nga, Vincent Diong Weng

doi:10.1016/j.jocn.2021.05.036

Cited by 9 publications

(14 citation statements)

References 35 publications

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“…Refer to the criteria for the evaluation of the efficacy of ACS complicated with atrial fibrillation in the guidelines (2016) [ 13 ], which are effective: symptoms such as angina pectoris basically disappear; effective: the clinical symptoms are significantly improved, and the degree of symptoms is reduced by 50%; ineffective: the clinical symptoms are not alleviated or even aggravated. Total effective = effective + effective.…”

Section: Methodsmentioning

confidence: 99%

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Liu

Qiu

Yang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Based on a retrospective cohort study, to investigate the value of rivaroxaban combined with ticagrelor in antithrombotic therapy after PCI in patients with nonvalvular atrial fibrillation with acute coronary syndrome. Methods. A total of 60 patients from January 2019 to May 2021 accepted therapy with antithrombotic therapy after PCI. The patients treated with ticagrelor were set as the control group, and those given rivaroxaban combined with ticagrelor were set as the research group. The curative effect, myocardial level, TIMI blood flow grade, platelet aggregation rate, and the incidence of cardiovascular events were taken from the comparisons. Results. The research group’s therapeutic impact was superior to the control group’s therapeutic impact, and the value was higher. After treatment, the myocardial levels of the two groups decreased, and the levels of troponin I, creatine kinase isoenzyme, and hypersensitive C-reactive protein in the research group were greatly less than those in the control group, and the difference was statistically significant ( P < 0.05 ). After operation, the TIMI blood flow classification in the experimental group was better than that in the control group, and the difference was statistically significant ( P < 0.05 ). The experimental group’s platelet aggregation incidence was considerably lower than the control group’s platelet aggregation incidence at 0.5 and 2 hours following surgery, and the difference was statistically significant ( P < 0.05 ). The incidence of acute myocardial infarction, cardiogenic death, and intractable angina pectoris in the research group was significantly lower than that in the control group. Conclusion. Rivaroxaban combined with ticagrelor in the treatment of nonvalvular atrial fibrillation with acute coronary syndrome after percutaneous coronary intervention; the TIMI blood flow grade is better than ticagrelor, which is of great significance to reduce mortality and has high safety in clinical application.

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Section: Methodsmentioning

confidence: 99%

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Liu

Qiu

Yang

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…12 Patients were restarted on antithrombotic therapy within varying time frames with no significant association found between time to resumption and recurrence or recurrence after resumption. 12 Further studies have shown that there are no significant differences in recurrence rates from early surgery, 0 to 2 days from antiplatelet cessation, compared with elective surgery, 5 days or more after antiplatelet cessation. 13 In our study, good clinical outcome was defined as modified Rankin Score ≤ 2 which was not significantly different between 2 groups ( P = .79).…”

Section: Discussionmentioning

confidence: 99%

Outcome of Chronic Subdural Hematoma Intervention in Patients on Long-Term Antiplatelet Therapy—A Propensity Score Matched Analysis

et al. 2023

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BACKGROUND: Patients presenting with chronic subdural hematomas (cSDHs) and on antiplatelet medications for various medical conditions often complicate surgical decision making. OBJECTIVE: To evaluate risks of preprocedural and postprocedural antiplatelet use in patients with cSDHs. METHODS: Patients with cSDH who were treated between January 2006 and February 2022 at a single institution with surgical intervention were identified. A propensity score matching analysis was then performed analyzing length of hospitalization, periprocedural complications, reintervention rate, rebleeding risk, and reintervention rates. RESULTS: Preintervention, 178 patients were on long-term antiplatelet medication and 298 were not on any form of antiplatelet. Sixty matched pairs were included in the propensity score analysis. Postintervention, 88 patients were resumed on antiplatelet medication, whereas 388 patients did not have resumption of antiplatelets. Fifty-five pairs of matched patients were included in the postintervention propensity score analysis. No significant differences were found in length of hospitalization (7.8 ± 4.2 vs 6.8 ± 5.4, P = .25), procedural complications (3.3% vs 6.7%, P = .68), or reintervention during the same admission (3.3% vs 5%, P = 1). No significant differences were seen in recurrence rate (9.1% vs 10.9%, P = 1) or reintervention rate after discharge (7.3% vs 9.1%, P = 1) in the postintervention group. CONCLUSION: Preintervention antiplatelet medications before cSDH treatment do not affect length of hospitalization, periprocedural complications, or reintervention. Resumption of antiplatelet medication after cSDH procedures does not increase the rebleeding risk or reintervention rate.

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“…It is essential to mention that most of these studies were retrospective and were not conducted as RCTs, thus limiting clinicians' ability to draw solid conclusions. 24 Zhang et al 24 conducted a large retrospective study on 761 CSDH surgeries that resumed their prior AC/AP consumption. They concluded that resumption time between 14 and 84 days after the operation is safe and does not increase the recurrence rate (10.4%).…”

Section: Discussionmentioning

confidence: 99%

“…The later the prophylactic AC is initiated, the higher the VTE probability will be expected. It is essential to mention that most of these studies were retrospective and were not conducted as RCTs, thus limiting clinicians’ ability to draw solid conclusions 24 …”

Section: Discussionmentioning

confidence: 99%

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

et al. 2023

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AimPatients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.Patients and MethodsThis study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur‐hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value <.05 was defined significant.ResultsA total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow‐up duration was 19.139 ± 2.2 months. Long‐term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).ConclusionIn terms of VTE chemoprophylaxis, following bur‐hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.

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Impact of time to resumption of antithrombotic therapy on outcomes after surgical evacuation of chronic subdural hematoma: A multicenter cohort study

Cited by 9 publications

References 35 publications

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

The Value of Rivaroxaban Combined with Ticagrelor in Antithrombotic Therapy after PCI in Patients with Nonvalvular Atrial Fibrillation with Acute Coronary Syndrome

Outcome of Chronic Subdural Hematoma Intervention in Patients on Long-Term Antiplatelet Therapy—A Propensity Score Matched Analysis

Enoxaparin initiation after chronic subdural haematoma evacuation: a randomized clinical trial on timing and outcomes

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