Subdural hematoma cases identified through a Danish patient register: diagnosis validity, clinical characteristics, and preadmission antithrombotic drug use

Poulsen, Frantz Rom; Halle, Bo; Pottegård, Anton; Rodrı́guez, Luis A. Garcı́a; Hallas, Jesper; Garcı́a-Dorado, David

doi:10.1002/pds.4058

Cited by 30 publications

(38 citation statements)

References 25 publications

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“…It has previously been shown that the subdural hematoma code used to identify cases in this study is highly valid with a positive predictive value of 96%. 15 This study has several limitations. Even though the approach used in this study enabled the identification of subdural hematoma incident cases with minimal misclassification, it probably resulted in incomplete coverage.…”

Section: Discussionmentioning

confidence: 99%

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Association of Antithrombotic Drug Use With Subdural Hematoma Risk

Garcı́a-Dorado

Rodrı́guez

Hellfritzsch

et al. 2017

JAMA

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143

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Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown.OBJECTIVES To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural hematoma incidence and antithrombotic drug use in the general population. DESIGN, SETTING, AND PARTICIPANTSCase-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400 380 individuals from the general population (controls). Subdural hematoma incidence and antithrombotic drug use was identified using population-based regional data (population: 484 346) and national data (population: 5.2 million) from Denmark. Conditional logistic regression models were used to estimate odds ratios (ORs) that were adjusted for comorbidity, education level, and income level.EXPOSURES Use of low-dose aspirin, clopidogrel, a vitamin K antagonist (VKA), a direct oral anticoagulant, and combined antithrombotic drug treatment.MAIN OUTCOMES AND MEASURES Association of subdural hematoma with antithrombotic drug use, subdural hematoma incidence rate, and annual prevalence of treatment with antithrombotic drugs. RESULTS Among 10 010 patients with subdural hematoma (mean age, 69.2 years; 3462 women [34.6%]), 47.3% were taking antithrombotic medications. Current use of low-dose aspirin (cases: 26.7%, controls: 22.4%; adjusted OR, 1.24 [95% CI, 1.15-1.33]), clopidogrel (cases: 5.0%, controls: 2.2%; adjusted OR, 1.87 [95% CI, 1.57-2.24]), a direct oral anticoagulant (cases: 1.0%, controls: 0.6%; adjusted OR, 1.73 [95% CI, 1.31-2.28]), and a VKA (cases: 14.3%, controls: 4.9%; adjusted OR, 3.69 [95% CI, 3.38-4.03]) were associated with higher risk of subdural hematoma. The risk of subdural hematoma was highest when a VKA was used concurrently with an antiplatelet drug (low-dose aspirin and a VKA: 3.6% of cases and 1.1% of controls; adjusted OR, 4.00 [95% CI,; clopidogrel and a VKA: 0.3% of cases and 0.04% of controls; adjusted OR, 7.93 [95% CI, 4.49-14.02]). The prevalence of antithrombotic drug use increased from 31.0 per 1000 individuals from the general population in 2000 to 76.9 per 1000 individuals in 2015 (P < .001 for trend). The overall subdural hematoma incidence rate increased from 10.9 per 100 000 person-years in 2000 to 19.0 per 100 000 person-years in 2015 (P < .001 for trend). The largest increase was among older patients (>75 years; n = 4441) who experienced an increase from 55.1 per 100 000 person-years to 99.7 per 100 000 person-years (P < .001 for trend). CONCLUSIONS AND RELEVANCEIn Denmark, antithrombotic drug use was associated with higher risk of subdural hematoma; and the highest odds of subdural hematoma was associated with combined use of a VKA and an antiplatelet drug. The increased incidence of subdural hematoma from 2000 to 2015 appears to be associated with the increased use of antithrombotic drugs, particularly us...

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Section: Discussionmentioning

confidence: 99%

“…15 Use of an antithrombotic drug by the validated cases and their general population controls was assessed for the period from 2000 to 2012 when data were available.…”

Section: Regional Datamentioning

confidence: 99%

Association of Antithrombotic Drug Use With Subdural Hematoma Risk

Garcı́a-Dorado

Rodrı́guez

Hellfritzsch

et al. 2017

JAMA

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143

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“…Chronic subdural hematoma is one of the most frequent diagnoses in neurosurgery 1,2,3 . It is characterized by an intracranial hemorrhage with a history of trauma in 50% of patients and occurs predominantly in males and in the elderly 7,10,20,21 .…”

Section: Discussionmentioning

confidence: 99%

“…Chronic subdural hematoma (CSDH) is characterized by a chronic deposition of clot in the subdural space, usually with favorable prognosis 1,2 . It is a frequent neurosurgical condition, commonly associated with a previous history of trauma 3 .…”

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The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

Heringer

Sousa

Oliveira

et al. 2017

Arq. Neuro-Psiquiatr.

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Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

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The importance of validating intracranial bleeding diagnoses in The Health Improvement Network, United Kingdom: Misclassification of onset and its impact on the risk associated with low‐dose aspirin therapy

Soriano

Garcı́a-Dorado

Soriano‐Gabarró

et al. 2018

Pharmacoepidemiology and Drug

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Purpose: To evaluate misclassification of intracranial bleeding (ICB) onset in TheHealth Improvement Network and assess its impact on risk associated with low-dose aspirin preventive therapy. Methods:A total of 199 049 new users of low-dose aspirin and 1:1 matched nonusers were followed to identify incident ICB cases with validation involving manual review of patient records and linked hospital data. The index date was the date of the recorded diagnosis (initial cases). After a second manual review including free text comments, the index date was backdated to the first symptom date; prevalent cases were excluded. Two nested case-control analyses were undertaken: using initial cases and using final cases (with backdated index date). Current, recent, and past low-dose aspirin use was defined as 0 to 7, 8 to 90, and 91 to 365 days before the index date, respectively.Results: Among 1635 initial and 1611 final ICB cases, there were, respectively, 37% vs 38% current users of low-dose aspirin, 10% vs 8% recent users, and 7% vs 7% past users. Current users with duration <3 months accounted for 6% of initial cases and 4% of final cases. Compared with never use, odds ratios (95% confidence intervals) using initial and final cases, respectively, were current use 0.97 (0.84-1.12) vs 0.97 (0.84-1.12); <3 months current use, 1.65 (1.28-2.13) vs 1.13 (0.85-1.50); recent use 1.52(1.24-1.88) vs 1.10 (0.88-1.37); and past use 1.30 (1.03-1.64) vs 1.17 (0.92-1.48). Conclusions:Misclassifying ICB onset in The Health Improvement Network marginally impacts the categorization of low-dose aspirin use yet notably affects estimates of associated risk.

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Subdural hematoma cases identified through a Danish patient register: diagnosis validity, clinical characteristics, and preadmission antithrombotic drug use

Cited by 30 publications

References 25 publications

Association of Antithrombotic Drug Use With Subdural Hematoma Risk

Association of Antithrombotic Drug Use With Subdural Hematoma Risk

The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas

The importance of validating intracranial bleeding diagnoses in The Health Improvement Network, United Kingdom: Misclassification of onset and its impact on the risk associated with low‐dose aspirin therapy

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