J Korean Neurosurg Soc.  2020 Jul;63(4):513-518. 10.3340/jkns.2019.0194.

Influence of Antithrombotic Medication on the Risk of Chronic Subdural Hematoma Recurrence after Burr-Hole Surgery

• Choi J
• Pyen J
• Cho S
• Kim J
• Koo Y
• Whang K

• KMID: 2504646
• DOI: http://doi.org/10.3340/jkns.2019.0194

Abstract

Objective
: Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have not yet been clearly identified and studies have reported varying results.
Methods
: We analyzed 230 patients with CSDH who were treated with burr-hole trephination and drainage at our institution from March 2011 to March 2016. The patients were divided into recurrence and non-recurrence groups and the medical records of each group were used to analyze the risk factors associated with CSDH recurrence.
Results
: After burr-hole trephination and drainage, CSDH recurrence was observed in 49 (21.3%) of the 230 patients. In univariate analysis, none of the factors showed statistical significance with respect to CSDH recurrence. In multivariate analysis, preoperative antithrombotic medication was the only independent risk factor for CSDH recurrence (odds ratio, 2.407; 95% confidence interval, 1.047–5.531).
Conclusion
: The present study found that preoperative antithrombotic medication was independently associated with CSDH recurrence.

Keyword

Hematoma, Subdural, Chronic; Recurrence; Anticoagulants; Platelet aggregation inhibitors

Reference

References

1. Abe Y, Maruyama K, Yokoya S, Noguchi A, Sato E, Nagane M, et al. Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness. J Neurosurg. 126:1042–1046. 2017.

2. Aspegren OP, Astrand R, Lundgren MI, Romner B. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma. Clin Neurol Neurosurg. 115:981–984. 2013.

3. Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E. Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir (Wien). 154:1549–1554. 2012.

4. Drapkin AJ. Chronic subdural hematoma: Pathophysiological basis for treatment. Br J Neurosurg. 5:467–473. 1991.

5. Echlin FA, Sordillo SV, Garvey TQ Jr. Acute, subacute, and chronic subdural hematoma. J Am Med Assoc. 161:1345–1350. 1956.

6. Fleck RA, Rao LV, Rapaport SI, Varki N. Localization of human tissue factor antigen by immunostaining with monospecific, polyclonal antihuman tissue factor antibody. Thromb Res. 59:421–437. 1990.

7. Fornebo I, Sjåvik K, Alibeck M, Kristiansson H, Ståhl F, Förander P, et al. Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation: a population-based consecutive cohort study. Acta Neurochir (Wien). 159:2045–2052. 2017.

8. Fujitani S, Ishikawa O, Miura K, Takeda Y, Goto H, Maeda K. Factors predicting contralateral hematoma growth after unilateral drainage of bilateral chronic subdural hematoma. J Neurosurg. 126:755–759. 2017.

9. Gernsback J, Kolcun JP, Jagid J. To drain or two drains: recurrences in chronic subdural hematomas. World Neurosurg. 95:447–450. 2016.

10. Jung YG, Jung NY, Kim E. Independent predictors for recurrence of chronic subdural hematoma. J Korean Neurosurg Soc. 57:266–270. 2015.

11. Kolias AG, Chari A, Santarius T, Hutchinson PJ. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 10:570–578. 2014.

12. Markwalder TM. Chronic subdural hematomas: a review. J Neurosurg. 54:637–645. 1981.

13. Motoie R, Karashima S, Otsuji R, Ren N, Nagaoka S, Maeda K, et al. Recurrence in 787 patients with chronic subdural hematoma: retrospective cohort investigation of associated factors including direct oral anticoagulant use. World Neurosurg. 118:e87–e91. 2018.

14. Nathan S, Goodarzi Z, Jette N, Gallagher C, Holroyd-Leduc J. Anticoagulant and antiplatelet use in seniors with chronic subdural hematoma: systematic review. Neurology. 88:1889–1893. 2017.

15. Obana WG, Pitts LH. Management of head injury. Extracerebral lesions. Neurosurg Clin N Am. 2:351–372. 1991.

16. Phan K, Abi-Hanna D, Kerferd J, Lu VM, Dmytriw AA, Ho YT, et al. Resumption of antithrombotic agents in chronic subdural hematoma: a systematic review and meta-analysis. World Neurosurg. 109:e792–e799. 2018.

17. Phuenpathom N, Choomuang M, Ratanalert S. Outcome and outcome prediction in acute subdural hematoma. Surg Neurol. 40:22–25. 1993.

18. Poon MTC, Al-Shahi Salman R. Association between antithrombotic drug use before chronic subdural haematoma and outcome after drainage: a systematic review and meta-analysis. Neurosurg Rev. 41:439–445. 2018.

19. Poon MTC, Rea C, Kolias AG, Brennan PM; British Neurosurgical Trainee Research Collaborative (BNTRC). Influence of antiplatelet and anticoagulant drug use on outcomes after chronic subdural hematoma drainage. J Neurotrauma. 2019; [Epub ahead of print].

20. Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci. 13:823–827. 2006.

21. Tugcu B, Tanriverdi O, Baydin S, Hergunsel B, Günaldı Ö, Ofluoglu E, et al. Can recurrence of chronic subdural hematoma be predicted? A retrospective analysis of 292 cases. J Neurol Surg A Cent Eur Neurosurg. 75:37–41. 2014.

22. Wang H, Zhang M, Zheng H, Xia X, Luo K, Guo F, et al. The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: a meta-analysis. Medicine (Baltimore). 98:e13972. 2019.

23. Wang Y, Zhou J, Fan C, Wang D, Jiao F, Liu B, et al. Influence of antithrombotic agents on the recurrence of chronic subdural hematomas and the quest about the recommencement of antithrombotic agents: a meta-analysis. J Clin Neurosci. 38:79–83. 2017.

24. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry. 74:937–943. 2003.

25. Wilson D, Charidimou A, Shakeshaft C, Ambler G, White M, Cohen H, et al. Volume and functional outcome of intracerebral hemorrhage according to oral anticoagulant type. Neurology. 86:360–366. 2016.

26. Won SY, Dubinski D, Bruder M, Cattani A, Seifert V, Konczalla J. Acute subdural hematoma in patients on oral anticoagulant therapy: management and outcome. Neurosurg Focus. 43:E12. 2017.