Influence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: A multicenter retrospective study in 719 patients

Abstract Objective The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. Method We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admit...

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Published in:Clinical neurology and neurosurgery 2014-05, Vol.120, p.49-54
Main Authors: Wada, Masanori, Yamakami, Iwao, Higuchi, Yoshinori, Tanaka, Mikio, Suda, Sumio, Ono, Junichi, Saeki, Naokatsu
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Antiplatelet agents
Coma
Confidence intervals
Consciousness
Craniotomy - adverse effects
Demographics
Diabetes
Female
Hematoma
Hematoma, Subdural, Chronic - chemically induced
Hematoma, Subdural, Chronic - epidemiology
Hematoma, Subdural, Chronic - surgery
Hospitals
Humans
Hypertension
Japan - epidemiology
Male
Medical imaging
Middle Aged
Multivariate analysis
Neurology
Neurosurgery
Platelet Aggregation Inhibitors - adverse effects
Postoperative Complications - chemically induced
Postoperative Period
Recurrence
Retrospective Studies
Risk Factors
Subdural
Surgery
Tomography
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Summary:Abstract Objective The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. Method We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. Results Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% ( p value < 0.0001; odds ratio, 3.77; 95% confidence interval, 1.72–8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. Conclusion Antiplatelet therapy significantly influences the recurrence of CSDH.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2014.02.007