The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort - Report - MDSpire
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The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort
Impact of Antithrombotic Treatment on Recurrence and Outcomes of Chronic Subdural Hematoma
Overview
In a community-based cohort of 301 patients undergoing burr-hole craniostomy for chronic subdural hematoma (CSDH), antithrombotic treatment (ATT) was not associated with increased hematoma recurrence. The study found a 15.8% recurrence rate and a 27.9% three-year mortality, with no significant difference in recurrence between patients with or without ATT.
Background
Chronic subdural hematoma is a common neurosurgical condition in the elderly, often related to mild or absent head trauma and influenced by risk factors such as age, male gender, alcohol use, and antithrombotic therapy. Surgical treatment via burr-hole craniostomy is standard for symptomatic cases. The impact of ATT on CSDH outcomes and recurrence remains controversial, especially given the risks of thromboembolic events when ATT is temporarily discontinued. This study retrospectively analyzed a population-based cohort from Eastern Finland to clarify these associations.
Data Highlights
Parameter
Value
Number of patients
301
Mean age (years)
76.6 ± 10.4
Male patients
66.4%
Patients on ATT
54.5%
Warfarin users
95
Low-dose ASA users
56
Hematoma recurrence rate
15.8%
3-year mortality
27.9%
Mean time to reoperation (ATT users)
43.0 days
Mean time to reoperation (non-ATT users)
54.1 days
Key Findings
54.5% of patients were on antithrombotic treatment at diagnosis, predominantly warfarin and low-dose aspirin.
Hematoma recurrence requiring surgery occurred in 15.8% of patients within 6 months.
There was no significant association between ATT use and hematoma recurrence (54.2% vs. 55.3%, p = 0.886).
The mean time to reoperation was shorter in ATT users but not statistically significant (43.0 vs. 54.1 days, p = 0.323).
Patients with recurrence resumed ATT significantly later than those without recurrence.
The overall 3-year mortality was 27.9%, reflecting the elderly and comorbid population.
Clinical Implications
Temporary discontinuation of antithrombotic therapy in patients undergoing burr-hole craniostomy for CSDH does not appear to increase the risk of hematoma recurrence. Clinicians should carefully balance the timing of ATT resumption to minimize both bleeding and thromboembolic risks. Close monitoring and individualized management strategies remain essential in this high-risk population.
Conclusion
Antithrombotic treatment does not significantly affect recurrence rates of chronic subdural hematoma after burr-hole craniostomy. These findings support the safe surgical management of CSDH in patients on ATT with careful perioperative medication management.
References
Study Authors/Kuopio University Hospital/2024 -- Impact of Antithrombotic Treatment on Recurrence and Outcomes of Chronic Subdural Hematoma
