Chronic subdural hematoma—antithrombotics and thrombotic complications

Hamou, Hussam Aldin; Clusmann, Hans; Schulz, Jörg B.; Wiesmann, Martin; Altiok, Ertunc; Höllig, Anke

doi:10.3238/arztebl.m2022.0144

Cited by 11 publications

(12 citation statements)

References 42 publications

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“…Hamou et al reported an incidence of 10 cases of stroke in 395 cases of CSDH in their series. 7 In their literature review, they further found that the risk of thrombotic complications was significantly increased in patients on anticoagulants however, there was no increase in the thrombotic complication risk in patients on aminosalicylic acid.…”

Section: Discussionmentioning

confidence: 98%

“…12 Use of antithrombotics/antiplatelets and previous history of valvular heart disease and atrial fibrillation have also been reported to be associated with the risk of stroke after CSDH. 7, 6 The diagnosis of a stroke can be made rapidly using an MRI which shows diffusion restriction in the affected arterial territories. Alkhachroum et al reported the use of transcranial Doppler to determine the arterial flow velocities of intracranial arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Hamou et al reported 10 cases of stroke in 395 patients of CSDH. 7 Herein we report the findings of two patients who suffered from an ischaemic stroke after evacuation of chronic SDH.…”

Section: Introductionmentioning

confidence: 96%

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Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease

Datta,

Chatterjee

2023

Journal of Stroke Medicine

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Background Chronic subdural haematoma (CSDH) is a common neurosurgical disease, particularly among the elderly, especially those on antiplatelet or anticoagulation with trivial trauma. While anticoagulants/antiplatelets increase the chance of rebleeding in cases of CSDH, discontinuation may increase the risk of stroke in these patients. Case Description: We report two cases of CSDH in elderly patients with risk factors who suffered from an ischaemic stroke after undergoing surgery. The first case was an elderly gentleman who had a history of percutaneous coronary intervention, presenting with a CSDH. He developed an anterior cerebral artery infarct in the immediate postoperative period. The second was an elderly gentleman with a history of hypertension presenting with a concomitant left thalamic infarct and large left-sided CSDH. He developed a second middle cerebral artery infarct of the opposite side in the immediate postoperative period. Conclusion: The medications used for stroke prophylaxis, that is, antiplatelets and anticoagulants are predisposing factors for the development of CSDH. However, the perioperative period of these patients remains vulnerable to the development of new-onset ischaemic stroke.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease

Datta,

Chatterjee

2023

Journal of Stroke Medicine

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“…Pathogenesis of cSDH comprises fibrinolysis and liquefication of the initial blood clot, secondary local inflammatory response, and subsequent formation of space-occupying subdural neo-membranes up to ten days after injury [4,5]. Apart from older age, known risk factors of cSDH are male gender, therapeutic anticoagulation and bleeding disorders, alcohol abuse, diabetes mellitus, and arterial hypertension [6][7][8]. Specifically, subnormal factor XIII activity due to polymorphism in coding genes F13A1 rs2815822 [9] and F13B rs12134960 [10] is associated with an enhanced risk of postoperative intracranial bleeding [11].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Middle Meningeal Artery Embolization Minimizes Burdensome Recurrence Rates After Newly Diagnosed Chronic Subdural Hematoma Evacuation (MEMBRANE): study protocol for a randomized controlled trial

Hoenning

Lemcke

Rot

et al. 2022

Trials

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Background Chronic subdural hematoma (cSDH) is the most common complication of mild traumatic brain injury demanding neurosurgery in high-income countries. If undetected and untreated, cSDH may increase intracranial pressure and cause neurological deficiencies. The first-line intervention of choice is burr hole trepanation and hematoma evacuation. However, any third patient may experience rebleeding, demanding craniotomy with excess morbidity. Adjunct endovascular embolization of the frontal and parietal branches of the middle meningeal artery (MMA) is a promising approach to avoid relapse and revision but was hitherto not studied in a randomized trial. Methods MEMBRANE is an investigator-initiated, single-center, randomized controlled trial. Male, female, and diverse patients older than 18 years scheduled for surgical evacuation of a first cSDH will be assigned in a 1:1 fashion by block randomization to the intervention (surgery plus endovascular MMA embolization) or the control group (surgery alone). The primary trial endpoint is cSDH recurrence within 3 months of follow-up after surgery. Secondary endpoints comprise neurological deficits assessed by the modified Rankin Scale (mRS) and recurrence- or intervention-associated complications during 3 months of follow-up. Assuming a risk difference of 20% of rebleeding and surgical revision, a power of 80%, and a drop-out rate of 10%, 154 patients will be enrolled onto this trial, employing an adaptive O’Brien-Fleming approach with a planned interim analysis halfway. Discussion The MEMBRANE trial will provide first clinical experimental evidence on the effectiveness of endovascular embolization of the MMA as an adjunct to surgery to reduce the risk of recurrence after the evacuation of cSDH. Trial registration German Clinical Trials Registry (Deutsches Register Klinischer Studien [DRKS]) DRKS00020465. Registered on 18 Nov 2021. ClinicalTrials.gov NCT05327933. Registered on 13 Apr 2022.

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“…The clinical appearance of cSDH varies considerably: some patients are asymptomatic; some present with symptoms such as headache, walking instability, cognitive impairment or focal neurological deficits; while others have a severe clinical presentation, with stupor or even coma [ 4 ]. As symptoms are nonspecific, diagnosis is usually confirmed with non-contrast computed tomography (CT) of the head, or more rarely, magnetic resonance imaging (MRI) [ 4 , 5 ]. Research is focusing on several biomarkers such as inflammatory cell ratio, activated partial thromboplastin time and prothrombin time to assess cSDH severity and surgical outcome.…”

Section: Introductionmentioning

confidence: 99%

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

et al. 2022

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Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. Surgical evacuation remains the mainstay of treatment in the overwhelming majority of cases. Nevertheless, many controversies are associated with the nuances of surgical treatment. We performed a systematic review of the literature between 2010 and 2022, aiming to identify and address the issues in cSDH surgical management where consensus is lacking. The results show ambiguous data in regard to indication, the timing and type of surgery, the duration of drainage, concomitant membranectomy and the need for embolization of the middle meningeal artery. Other aspects of surgical treatment—such as the use of drainage and its location and number of burr holes—seem to have been adequately clarified: the drainage of hematoma is strongly recommended and the outcome is considered as independent of drainage location or the number of burr holes.

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Chronic subdural hematoma—antithrombotics and thrombotic complications

Cited by 11 publications

References 42 publications

Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease

Ischaemic Stroke After Chronic Subdural Haematoma: An Uncommon Complication in a Common Disease

Middle Meningeal Artery Embolization Minimizes Burdensome Recurrence Rates After Newly Diagnosed Chronic Subdural Hematoma Evacuation (MEMBRANE): study protocol for a randomized controlled trial

Controversies in the Surgical Treatment of Chronic Subdural Hematoma: A Systematic Scoping Review

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