Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy

Rust, T.M.; Kiemer, Nicole; Erasmus, Albert

doi:10.1016/j.jocn.2004.12.013

Cited by 164 publications

(111 citation statements)

References 14 publications

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“…Old age, brain atrophy, poor health status at the time of admission, high bleeding tendency, accompanying kidney and liver diseases, chronic alcoholism, diabetes mellitus, epilepsy, dementia and intracranial hypotension due to cerebrospinal fluid shunt are reported to be relevant factors of CSDH re-currence (8,14,52). Especially anti-platelet agents and poor reexpansion of the brain have been suggested risk factors for recurrence of CSDH (52,55,56). As compatible with the literature, coagulopathy and brain atrophy are defined as two major risk factors for recurrence in the present study.…”

Section: Discussionmentioning

confidence: 99%

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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Section: Discussionmentioning

confidence: 99%

Treatment of chronic subdural hematoma: 5-year clinical experience

Oktay¹,

Olguner²,

Saraç³

et al. 2017

Eur J Ther

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“…2,3,25 The recurrence rates for cSDH in the recent literature range from 9% to 33%. 10,21,22 The predictors of recurrence are highly variable but include patient characteristics such as age and bilateral cSDH, radiographic variables such as preoperative hematoma width and morphology, and surgical and perioperative factors such as operative technique and choice of drainage system.…”

mentioning

confidence: 99%

“…10,15 The impact of AT on recurrence following surgical drainage, however, is controversial. 7,11,15,25,27,29 Balancing the risk of rebleeding with potential thromboembolic complications in these patients is an ongoing dilemma with scant evidence available to guide if and when therapeutic AT should be resumed postoperatively. 6 Here, we retrospectively analyzed a cohort of 479 patients who were treated surgically for cSDH at a single institution.…”

mentioning

confidence: 99%

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Guha

Coyne

Macdonald

2016

JNS

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C hroniC subdural hematoma (cSDH) is a disease of the elderly and demonstrates an incidence of approximately 3.4 patients per 100,000 persons younger than 65 years of age and 8 to 58 patients per 100,000 persons older than 65 years. 1,4,9 The prevalence of cSDH is expected to rise as the percentage of the United States population older than 65 years grows from 12% in 2003 to a projected 20% by 2030. 17Other identified risk factors for the development of cSDH include male sex, history of falls, chronic alcohol use, and antiplatelet or anticoagulant therapy, with warfarin increasing the relative risk of developing cSDH by aBBreViatiONS ADP = adenosine diphosphate; ASA = acetylsalicylic acid; AT = antithrombosis; CAD = coronary artery disease; cSDH = chronic subdural hematoma; DVT = deep venous thrombosis; INR = international normalized ratio; LMWH = low-molecular-weight heparin; TIA = transient ischemic attack. OBJectiVe Antithrombosis (AT), defined here as either antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDHs). Resuming AT following the evacuation of cSDH is a highly variable practice, with scant evidence in the literature for guidance. Here, a retrospective analysis of a cohort of patients from a single institution undergoing surgical drainage of cSDH was performed to evaluate postoperative complications and determine the optimal timing of the resumption of common antithrombotic agents. methOdS This retrospective analysis was performed on 479 patients undergoing surgical evacuation of cSDH at St. Michael's Hospital over a 5-year period (2007)(2008)(2009)(2010)(2011)(2012). The collected variables included the type of AT agent, indications for AT, timing and type of postoperative complications, and the restart intervals for the AT agents, when available. Postoperative complications were classified as major hemorrhages, minor hemorrhages, or thromboembolic events. reSultS Among all 479 study patients, 71 experienced major hemorrhage (14.8%), 110 experienced minor hemorrhage (23.0%), and 8 experienced thromboembolism (1.67%) postoperatively. Patients on any type of preoperative AT regimen were at a higher risk of major hemorrhage (19.0% vs 10.9%; OR 1.93; 95% CI 1.15-2.71; p = 0.014). The type of AT agent did not affect the frequency of any postoperative complications. Patients on any preoperative AT regimen experienced earlier postoperative major hemorrhages (mean 16.2 vs 26.5 days; p = 0.052) and thromboembolic events (mean 2.7 vs 51.5 days; p = 0.036) than those patients without a history of AT; the type of AT agent did not affect timing of complications. Patients who were restarted on any AT therapy postoperatively were at decreased risk of major rebleeding following resumption than those patients who were not restarted (OR 0.06; 95% CI 0.02-0.2; p < 0.01). cONcluSiONS Patients with a history of preoperative AT experienced thromboembolic complications significantly earlier than those patients without AT, which peaked at 3 days postoperative...

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“…In a recent systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials, Mc Quaid and Laine provided evidence that low-dose aspirin was associated with an increased risk of intracranial haemorrhage (without specifying which type of intracranial haemorrhage) and major bleedings. 11 A well described case-control study, instead, showed that the incidence of anticoagulant associated intracerebral haemorrhage in the US population quintupled during the 90s and the majority of that change was explained by increasing warfarin use. 12 Our results confirm that anticoagulant and antiplatelet/ anticoagulant therapy have a significant association with an increased risk of CSDH, with an OR of 1.23 (95% CI 0.68-2.34) and 1.42 (95% CI 0.48-4.2), respectively.…”

Section: Discussionmentioning

confidence: 99%

Effect of antiplatelet/anticoagulant agents in elderly patients of chronic subdural hematoma: a case control study from a tertiary care centre

2017

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Background: Bleedings are well known risks of both antiplatelet and anticoagulant therapy and both therapies have historically been considered as risk factors for CSDH. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma (CSDH).Methods: Single institution case-control study was conducted in patients older than 60 years who visited our academic tertiary care Emergency Department from January 2012 to December 2016. Patients with CSDH were identified by review of case and controls were selected with a 1:3 ratio for gender, age (60 years), year of admission and recent trauma.Results: There were 124 cases and 372 controls included in the study. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 1.22 (CI 95% 0.66-1.54) and 1.12 (CI 95% 0.68-1.54), respectively. While OR was 1.11 (CI 95% 0.54-2.32), 1.21 (CI 95% 0.61-2.45), and 0.53 (CI 95% 0.33-0.78) for patients receiving oral anticoagulants, ADP-antagonists, and Cox-inhibitors, respectively. History of recent trauma was an effective modifier of the association between anticoagulants and CSDH. OR of 1.69 (CI 95% 0.99-2.96) was found for patients with history of trauma and OR of 4.27 (CI 95% 2.23-8.32) for patients without history of trauma.Conclusions: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association appears even stronger in those patients under anticoagulant therapy, who develop a CSDH in the absence of a recent trauma.

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Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy

Cited by 164 publications

References 14 publications

Treatment of chronic subdural hematoma: 5-year clinical experience

Treatment of chronic subdural hematoma: 5-year clinical experience

Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Effect of antiplatelet/anticoagulant agents in elderly patients of chronic subdural hematoma: a case control study from a tertiary care centre

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