Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage.
Brennan, Paul M
British Neurosurgical Trainee Research Collaborative (BNTRC),
Journal of neurotrauma
Mary Ann Liebert
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Poon, M. T., Rea, C., Kolias, A., Brennan, P. M., & British Neurosurgical Trainee Research Collaborative (BNTRC),. (2021). Influence of Antiplatelet and Anticoagulant Drug Use on Outcomes after Chronic Subdural Hematoma Drainage.. Journal of neurotrauma, 38 (8), 1177-1184. https://doi.org/10.1089/neu.2018.6080
We aim to describe the outcomes following CSDH management in a large cohort of patients on antithrombotic drugs, either antiplatelets or anticoagulants, at presentation and to inform clinical decision making on the timing of surgery and recommencement of these drugs. We used data from a previous UK-based multicenter prospective cohort study. Outcomes included recurrence within 60 days, functional outcome at discharge, and thromboembolic event during hospital stay. We performed Cox regression on recurrence and multiple logistic regression on functional outcome. There were 817 patients included in the analysis, of which 353 (43.2%) were on an antithrombotic drug at presentation. We observed a gradual reduction in risk of recurrence for patients during the 6 weeks post CSDH surgery. Neither antiplatelet nor anticoagulant drug use influenced risk of CSDH recurrence (hazard ratio 0.93; 95% confidence interval [CI] 0.58-1.48; p=0.76) or persistent/worse functional impairment (odds ratio 1.08; 95% CI 0.76-1.55; p=0.66). Delaying surgery after cessation of antiplatelet drug did not affect risk of bleed recurrence. There were 15 in-hospital thromboembolic events recorded. Events were more common in the group pre-treated with antithrombotic drugs (3.3%) compared with the non-antithrombotic group (0.9%). Patients on an antithrombotic drug pre-operatively were at higher risk of thromboembolic events with no excess risk of bleed recurrence or worse functional outcome after CSDH drainage. The data did not support delaying surgery in patients on antithrombotic therapy. In the absence of a randomized controlled trial, early surgery and early antithrombotic recommencement should be considered in those at high risk of thromboembolic events.
British Neurosurgical Trainee Research Collaborative (BNTRC)
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/12/35/57)
NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) (HTA/13/15/02)
External DOI: https://doi.org/10.1089/neu.2018.6080
This record's URL: https://www.repository.cam.ac.uk/handle/1810/287485