J Korean Neurosurg Soc.  2012 Sep;52(3):234-239.

Recent Changes in Risk Factors of Chronic Subdural Hematoma

• Sim YW
• Min KS
• Lee MS
• Kim YG
• Kim DH

Abstract

OBJECTIVE
Chronic subdural hematoma (CSDH) is a typical disease that is encountered frequently in neurosurgical practice. The medications which could cause coagulopathies were known as one of the risk factors of CSDH, such as anticoagulants (ACs) and antiplatelet agents (APs). Recently, the number of patients who are treated with ACs/APs is increasing, especially in the elderly population. With widespread use of these drugs, there is a need to study the changes in risk factors of CSDH patients.
METHODS
We retrospectively reviewed 290 CSDH patients who underwent surgery at our institute between 1996 and 2010. We classified them into three groups according to the time of presentation (Group A : the remote period group, 1996-2000, Group B : the past period group, 2001-2005, and Group C : the recent period group, 2006-2010). Also, we performed the comparative analysis of independent risk factors between three groups.
RESULTS
Among the 290 patients, Group A included 71 patients (24.5%), Group B included 98 patients (33.8%) and Group C included 121 patients (41.7%). Three patients (4.2%) in Group A had a history of receiving ACs/APs, 8 patients (8.2%) in Group B, and 19 patients (15.7%) in Group C. Other factors such as head trauma, alcoholism, epilepsy, previous neurosurgery and underlying disease having bleeding tendency were also evaluated. In ACs/APs related cause of CSDH in Group C, significantly less proportion of the patients are associated with trauma or alcohol compared to the non-medication group.
CONCLUSION
In this study, the authors concluded that ACs/APs have more importance as a risk factor of CSDH in the recent period compared to the past. Therefore, doctors should prescribe these medications carefully balancing the potential risk and benefit.

Keyword

Chronic subdural hematoma; Anticoagulants; Antiplatelet agents; Risk factors

MeSH Terms

Aged
Alcoholism
Anticoagulants
Craniocerebral Trauma
Epilepsy
Hematoma, Subdural, Chronic
Hemorrhage
Humans
Neurosurgery
Platelet Aggregation Inhibitors
Retrospective Studies
Risk Factors
Anticoagulants
Platelet Aggregation Inhibitors

Reference

1. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma : results of a large single-center cohort study. Neurosurg Rev. 2004; 27:263–266. PMID: 15148652.

2. Bershad EM, Farhadi S, Suri MF, Feen ES, Hernandez OH, Selman WR, et al. Coagulopathy and inhospital deaths in patients with acute subdural hematoma. J Neurosurg. 2008; 109:664–669. PMID: 18826353.

3. The Stroke Prevention in Atrial Fibrillation Investigators. Bleeding during antithrombotic therapy in patients with atrial fibrillation. Arch Intern Med. 1996; 156:409–416. PMID: 8607726.

4. Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am. 2000; 11:399–406. PMID: 10918008.

5. Choi WW, Kim KH. Prognostic factors of chronic subdural hematoma. J Korean Neurosurg Soc. 2002; 32:18–22.

6. Forster MT, Mathé AK, Senft C, Scharrer I, Seifert V, Gerlach R. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma. J Clin Neurosci. 2010; 17:975–979. PMID: 20580997.

7. Gonugunta V, Buxton N. Warfarin and chronic subdural haematomas. Br J Neurosurg. 2001; 15:514–517. PMID: 11814005.

8. Gorelick PB, Weisman SM. Risk of hemorrhagic stroke with aspirin use : an update. Stroke. 2005; 36:1801–1807. PMID: 16020759.

9. Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses. Stroke. 1995; 26:1471–1477. PMID: 7631356.

10. Jeong JE, Kim GK, Park JT, Lim YJ, Kim TS, Rhee BA, et al. A clinical analysis of chronic subdural hematoma according to age factor. J Korean Neurosurg Soc. 2000; 29:748–753.

11. Kang HL, Shin HS, Kim TH, Hwang YS, Park SK. Clinical analysis of recurrent chronic subdural hematoma. J Korean Neurosurg Soc. 2006; 40:262–266.

12. Kang MS, Koh HS, Kwon HJ, Choi SW, Kim SH, Youm JY. Factors influencing recurrent chronic subdural hematoma after surgery. J Korean Neurosurg Soc. 2007; 41:11–15.

13. Ko BS, Lee JK, Seo BR, Moon SJ, Kim JH, Kim SH. Clinical analysis of risk factors related to recurrent chronic subdural hematoma. J Korean Neurosurg Soc. 2008; 43:11–15. PMID: 19096538.

14. Kwon HJ, Youm JY, Kim SH, Koh HS, Song SH, Kim Y. Postoperative radiological changes in chronic subdural hematoma and its relation to recurrence. J Korean Neurosurg Soc. 2004; 35:410–414.

15. Lee JK, Choi JH, Kim CH, Lee HK, Moon JG. Chronic subdural hematomas : a comparative study of three types of operative procedures. J Korean Neurosurg Soc. 2009; 46:210–214. PMID: 19844620.

16. Lindvall P, Koskinen LO. Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clin Neurosci. 2009; 16:1287–1290. PMID: 19564115.

17. Majeed A, Moser K, Carroll K. Trends in the prevalence and management of atrial fibrillation in general practice in England and Wales, 1994-1998 : analysis of data from the general practice research database. Heart. 2001; 86:284–288. PMID: 11514479.

18. Markwalder TM. Chronic subdural hematomas : a review. J Neurosurg. 1981; 54:637–645. PMID: 7014792.

19. Mattle H, Kohler S, Huber P, Rohner M, Steinsiepe KF. Anticoagulation related intracranial extracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 1989; 52:829–837. PMID: 2769275.

20. Quinones-Hinojosa A, Gulati M, Singh V, Lawton MT. Spontaneous intracerebral hemorrhage due to coagulation disorders. Neurosurg Focus. 2003; 15:E3. PMID: 15344896.

21. Roob G, Fazekas F. Magnetic resonance imaging of cerebral microbleeds. Curr Opin Neurol. 2000; 13:69–73. PMID: 10719653.

22. Spektor S, Agus S, Merkin V, Constantini S. Low-dose aspirin prophylaxis and risk of intracranial hemorrhage in patients older than 60 years of age with mild or moderate head injury : a prospective study. J Neurosurg. 2003; 99:661–665. PMID: 14567600.

23. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S. Independent predictors for recurrence of chronic subdural hematoma : a review of 343 consecutive surgical cases. Neurosurgery. 2008; 63:1125–1129. discussion 1129. PMID: 19008766.

24. Weir B, Gordon P. Factors affecting coagulation : fibrinolysis in chronic subdural fluid collections. J Neurosurg. 1983; 58:242–245. PMID: 6848682.

25. Wintzen AR, Tijssen JG. Subdural hematoma and oral anticoagulant therapy. Arch Neurol. 1982; 39:69–72. PMID: 7059302.

26. Zingale A, Chibbaro S, Florio A, Distefano G, Porcaro S. Management of chronic subdural hematoma in patients treated with anticoagulation. J Neurosurg Sci. 1999; 43:277–284. PMID: 10864390.