Article
The most common neurosurgical disease in 2030 – clinical management of antithrombotic medication, reoperation risk and outcome of 623 patients with chronic subdural haematoma
Die häufigste neurochirurgische Erkrankung in 2030 – klinisches Management von antithrombotischer Medikation, Reoperationsrisiko und Outcome von 623 Patienten mit chronischem Subduralhämatom
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Authors
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Alexander Younsi
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Lennart Riemann
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Cleo Habel
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Christopher Beynon
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
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Klaus Zweckberger
- Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: In our ageing Western society, the incidence of chronic subdural hematomas (cSDH) is raising while more and more affected patients are on antithrombotic drugs (anticoagulants or antiplatelets). In this study, we reviewed our clinical management of cSDH patients on antithrombotic drugs and examined their characteristics and clinical outcome in order to identify predictive factors for the need of reoperation due to rebleedings or recurrent hematomas within 30 days.
Methods: All consecutive patients who were treated for surgical cSDH evacuation at a single neurosurgical institution between 2006–2016 were retrospectively analyzed. Clinical and radiological characteristics as well as laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analysis. Clinical outcome measures were compared between the antithrombotics and no-antithrombotics group.
Results: 623 patients with a median age of 75 [68–81] years were identified. Antithrombotic drugs were used by every second patient. Prior to surgery (burr hole drainage in 93%), the effects of anticoagulants were mostly reversed (70%) whereas antiplatelet drugs were rarely antagonized (4%). Thromboembolic complications were rare (3%). Within 30 days after surgery, the risk for reoperation was 23%. In univariate analysis, this risk was significantly higher in patients on antithrombotic drugs. Multivariate analysis, however, revealed that only the presence of comorbidities, but not antithrombotic treatment itself, was an independent predictor for reoperation. Nevertheless, the risk for perioperative complications was significantly increased in patients with antithrombotics whereas the clinical outcome was comparable between both groups and generally good (median GOS 5 (4.5). Interestingly, the clinical outcome as well as the risk for reoperation did not differ between anticoagulant or antiplatelet therapy.
Conclusion: Patients on antithrombotics have a significantly increased risk for rebleedings that require reoperation. This however, might not be attributable to the medications themselves, but to predisposing chronic comorbidities which are more common in patients on antithrombotic drugs. Importantly, the clinical outcome after surgical evacuation is not inferior in patients on antithrombotics compared to cSDH patients without antithrombotic drugs.
