Statins as a Medical Adjunct in the Surgical Management of Chronic Subdural Hematomas

Guidry, Bradley S.; Kelly, Katherine A.; Yengo‐Kahn, Aaron M.; Lan, Matthews; Tang, Alan R.; Chotai, Silky; Morone, Peter J.; Kelly, Patrick

doi:10.1016/j.wneu.2021.02.036

Cited by 10 publications

(5 citation statements)

References 40 publications

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“…Those on statins, accounting for approximately 30% of all cSDH patients, were also omitted. [ 40 , 41 ]). Nonetheless, our study corroborates that hematoma volume influences the success of conservative therapy, even in a broader population.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis

Foppen,

Lodewijkx,

Bandral

et al. 2024

J Neurol

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Introduction Conservative therapy is a viable option for patients with chronic subdural hematoma (cSDH) who express no, or only mild symptoms. It is not clear which factors are associated with success of conservative therapy. This study aims to determine conservative therapy's success rate and to identify features possibly associated with success. Methods A monocenter retrospective cohort study, including cSDH patients treated conservatively (wait-and-watch) from 2012 to 2022, was performed. The primary outcome was success of conservative therapy, defined as ‘no crossover to surgery’ during the follow-up period. Secondary outcomes were (1) factors associated with success, analyzed with univariate and multivariable logistic regression analyses, (2) 30-day mortality (3) time to crossover and (4) reasons for crossover. Results We included 159 patients. Conservative therapy was successful in 96 (60%) patients. Hematoma volume (OR 0.79, 95% CI 0.69–0.92) and hypodense hematoma type (OR 3.57, 95% 1.38–9.23) were associated with success. Thirty-day mortality rate was 5% and the median duration between diagnosis and surgery was 19 days (IQR 8–39). Clinical deterioration was the most frequent reason for crossover (in 61/63 patients, 97%) and was accompanied by radiological hematoma progression in 42 patients (67%). Conclusion In this selected group of patients, conservative therapy was successful in 60%. Smaller hematoma volume and hypodense hematoma type were associated with success. As time until crossover was approximately three weeks, deploying conservative therapy as primary treatment seems safe and could be rewarding as surgical complications can be avoided. Improvement in patient selection in future cohorts remains warranted.

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Section: Discussionmentioning

confidence: 99%

Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis

Foppen,

Lodewijkx,

Bandral

et al. 2024

J Neurol

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“…There have been growing reports on the use of statins (HMG-CoA reductase inhibitors) [21][22][23][24], tranexamic acid [12][13][14][15]25] (antiplasminogen antifibrinolytic), a platelet-activating factor receptor antagonist (etizolam) [26,27], angiotensin-converting enzyme inhibitors [28][29][30], corticosteroids [31][32][33][34][35], goreisan [13,25,36,37], and antiangiogenic endovascular procedures like embolization of the distal middle meningeal artery (MMA) [38][39][40][41][42][43]. All medications used until now share a potential role on inflammatory processes underlying CSDH formation.…”

Section: Generalizationmentioning

confidence: 99%

Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial

et al. 2023

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Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. A prospective, randomized, and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Twenty-six patients were randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness, and drain use. Clinical and radiological recurrence occurred in three patients (6%), being two cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in two patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had two complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.

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“…Initially we have reached over 60 patients, but after exclusion criteria application nal number was twenty six (26) patients to control group and twenty-four (24) to experimental group.…”

Section: Sample Sizementioning

confidence: 99%

“…When patients have normal conscience status, no motor de cits, and/or controlled symptoms like seizures or headache some nonsurgical treatments are being tried. There have been growing reports on the use of statins (HMG-CoA reductase inhibitors) [21][22][23][24] , tranexamic acid [12][13][14][15]25 (antiplasminogen anti brinolytic), a platelet-activating factor receptor antagonist (etizolam) 26,27 , angiotensin-converting enzyme inhibitors 28-30 , corticosteroids [31][32][33][34][35] , goreisan 13,25,36,37 and antiangiogenic endovascular procedures like embolization of the distal middle meningeal artery (MMA) [38][39][40][41][42][43] . All medications used until now share a potential role on in ammatory processes underlying CSDH formation.…”

Section: Generalizationmentioning

confidence: 99%

Effect of Postoperative Tranexamic Acid on Recurrence Rate and Complications in Chronic Subdural Hematomas Patients: Preliminary Results of a Randomized Controlled Clinical Trial

Torres¹,

Ribeiro²,

Melo³

et al. 2023

Preprint

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Introduction. Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease, which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. Method. A prospective, randomized and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Results. Twenty-six patients were then randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 months to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness and drain use. Clinical and radiological recurrence occurred in 3 patients (6%), being 2 cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in 2 patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Discussion and Conclusion. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had 2 complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.

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Statins as a Medical Adjunct in the Surgical Management of Chronic Subdural Hematomas

Cited by 10 publications

References 40 publications

Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis

Factors associated with success of conservative therapy in chronic subdural hematoma: a single-center retrospective analysis

Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial

Effect of Postoperative Tranexamic Acid on Recurrence Rate and Complications in Chronic Subdural Hematomas Patients: Preliminary Results of a Randomized Controlled Clinical Trial

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