Optimal perioperative management of antithrombotic agents in patients with chronic subdural hematoma

Amano, Toshiyuki; Takahara, Kenta; Maehara, Naoki; Shimogawa, Takafumi; Mukae, Nobutaka; Sayama, Tetsuro; Arihiro, Shoji; Arakawa, Shuji; Morioka, Takato; Haga, Sei

doi:10.1016/j.clineuro.2016.10.002

Cited by 17 publications

(16 citation statements)

References 22 publications

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“…Of the remaining 17 articles, 9 were excluded because they were only about anticoagulants [24][25][26][27][28][29][30][31][32], one was excluded because the majority of participants who had resumed antithrombotic agents had their medicine terminated or changed during the follow-up [33], and one was excluded because there was no clear record of which kind of antithrombotic agents, oral anticoagulant, or AP therapy was resumed [34]. Finally, only 6 articles met the inclusion criteria [35][36][37][38][39][40]. The study selection is presented in flow chart form in Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…The 6 studies offered data containing 1916 patients (825 in AP resumption group, 1091 in non-AP resumption group) [35][36][37][38][39][40]. Pooled result using the random-effects model showed that there was no significant difference between AP resumption group and non-AP resumption group for ICH recurrence or hematoma expansion (RR, 0.84; 95% CI, 0.47-1.51; P = 0.56) (Fig.…”

Section: Ap Resumption Did Not Significantly Increase Ich Recurrence mentioning

confidence: 99%

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Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Ding

Liu

Tan

et al. 2018

Journal of the Neurological Sciences

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Section: Study Selectionmentioning

confidence: 99%

Section: Ap Resumption Did Not Significantly Increase Ich Recurrence mentioning

confidence: 99%

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Ding

Liu

Tan

et al. 2018

Journal of the Neurological Sciences

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“…The evidence on this issue is rather limited, and clinical guidelines do not exist. Previously, it has been demonstrated that the number of thromboembolic events tends to increase if the discontinuation of ATT is prolonged, and thus, generally prompt resumption is recommended [ 3 , 17 , 22 ]. However, no clear-cut evidence on the optimal duration of the length of the postoperative discontinuation exists [ 11 , 35 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort

et al. 2022

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Purpose To study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH). Methods A retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years. Results A total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013–3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089–5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events. Conclusions ATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.

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“…Despite being a relatively simple procedure, draining a CSDH can have significant complications, such as acute intracranial rebleeding (high-density in the cerebral parenchyma or subdural space on CT), 50 remote contralateral intraparenchymal hemorrhage, 51 subdural empyema, 51 epileptic seizure, 51 cerebellar hemorrhage, 26 postoperative hyperfusion syndrome, 52 tension postoperative pneumocephalus, 53 epidural hematoma, 54 postoperative thromboembolic complications, 55 and internal hemorrhagic pachymeningios 56 .…”

Section: Toward a Simpler Neurosurgical Approachmentioning

confidence: 99%

Guidance for chronic subdural hematoma surgery in the novel coronavirus pandemic (Covid-19)

Valênça¹,

Valença

Martins

et al. 2021

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Of great concern to the neurosurgical community is this novel coronavirus pandemic 2019, a result of dissemination to all continents of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Without proper care, there is a very high chance of being infected by the lethal SARS-CoV-2 during a routine neurosurgical procedure. SARS-CoV-2 infected a significant part of the healthcare workers, including neurosurgeons, responsible for direct care for patients with Covid-19, and several of those infected have already died. Drastic modifications should be made in the process the operating room is prepared, and in the attitudes taken by medical personnel in an attempt to minimize a possible contact of the SARS-CoV-2. The novel coronavirus is present not only in the respiratory tract, but the virus may also be encountered in blood, stool, and CSF. In this article, the authors want to address the topic of how the neurosurgeons can mitigate the chance of being infected with SARS-CoV-2 during a surgical procedure performed on a patient with Covid-19. For this, we chose a common condition in neurosurgery practice - and one of the simplest in its execution - the chronic subdural hematoma (CSDH). There is still no consensus on how to operate patients with CSDH. This article aimed to elaborate a protocol with effective and minimally invasive techniques to be performed in the patient with both CSDH and Covid-19, with the dual intention of protecting the surgeon from SARS-CoV-2 infection and optimizing the patient's chance of healing.

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Optimal perioperative management of antithrombotic agents in patients with chronic subdural hematoma

Cited by 17 publications

References 22 publications

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies

The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort

Guidance for chronic subdural hematoma surgery in the novel coronavirus pandemic (Covid-19)

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