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Journal of Neurosurgical Sciences 2018 Apr 18

DOI: 10.23736/S0390-5616.18.04311-4


language: English

Do antiplatelet and anticoagulant drugs modify outcome of patients treated for chronic subdural hematoma? Still a controversial issue

Alba SCERRATI 1 , Annunziato MANGIOLA 2, 3, Francesco RIGONI 1, Simone OLEI 1, Mariaconsiglia SANTANTONIO 3, Gianluca TREVISI 3, Carmelo ANILE 3, Michele A. CAVALLO 1, Pasquale DE BONIS 1

1 Neurosurgery, Sant’Anna University Hospital, Ferrara, Italy; 2 Neurosurgery, Chieti University G. D’Annunzio, Santo Spirito Hospital, Pescara, Italy; 3 Neurotrauma, Catholic University School of Medicine, Rome, Italy


BACKGROUND: Anticoagulants(ACs) and antiplatelet aggregation agents(AAAs) seem to be correlated to a higher incidence of chronic subdural hematoma(CSDH) but whether or not they contribute to its recurrence is debated. Few data are available on clinical outcomes and indications for the management of this therapy are not so well defined. We investigated the role of ACs and AAAs in modifying patients clinical outcomes treated for CSDH, especially for re-bleedings.
METHODS: This retrospective study, enrolled patients treated for CSDH. Patients characteristics were recorded including drugs used (antiplatelet/anticoagulant) and clinical conditions (Modified Rankin Scale-mRS) upon admission. Patients underwent surgery(burrhole vs minicraniectomy) with subdural drainage positioning. Clinical/radiological follow-ups were performed at one and six months. Chi square/Fisher exact test were used to compare variables and stepwise backward logistic regression analysis was used for defining their impact on complications, risk of re-bleeding and reoperation.
RESULTS: 230 patients (45 on ACs, 76 on AAAs and 9 on both)were enrolled. Higher mRS scores were significantly associated with a higher risk of general complications (OR = 3.78, CI 95% 1.66- 8.62, p=0.002), higher risk of rebleeding (OR =15.82, CI 95% 4.33-57.90, p <0.001) and re- operation (OR=11.39, CI 95% 3.35-37.56, p<0.0001). No statistically significant association was found between AAAs or ACs and complications or re- bleedings or risk of reoperation.
CONCLUSIONS: AAAs and ACs alone do not seem to worsen the clinical outcome or increase re- bleedings. mRS may be a predicting factor, since patients with higher scores showed a worse outcome and an increased risk of re-bleeding, general complications and reoperation.

KEY WORDS: Chronic subdural hematoma - Anticoagulant - Antithrombotic - Antiplatelet - Rebleeding

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