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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Anticoagulation withdrawal in patients with chronic subdural haematoma is associated risk of thrombembolism and higher mortality

Absetzen der Antikoagulation bei Patienten mit chronischem subduralen Hämatom geht einher mit Thrombembolien und höherer Mortalität

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  • presenting/speaker Hussam Aldin Hamou - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland
  • Hasan Zaytoun - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland
  • Mohamed Alzaiyani - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland
  • Michael Veldeman - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland
  • Hans Rainer Clusmann - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland
  • Anke Höllig - Rheinisch-Westfälische Technische Hochschule Aachen, Neurochirurgie, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV129

doi: 10.3205/20dgnc131, urn:nbn:de:0183-20dgnc1319

Published: June 26, 2020

© 2020 Hamou et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Chronic subdural hematoma (cSDH) is an entity with a high incidence particularly among the elderly (up to 8.2 per 100 000 per year in people above the age of 65). Due to the high average age the management of the patients is regularly hampered by the prior use of anticoagulant, especially as there are no specific guidelines for the treatment of this pathology. Here, we present a retrospective analysis of patients with cSDH with regards to the management of anticoagulant/antiplatelet use including the incidence of thromboembolic complications and the recurrence of the hematoma.

Methods: A total of 202 patients with cSDH (from October 2014 to July 2017) were included. Patient characteristics (age, sex, pre-existing conditions, use of anticoagulants/antiplatelets, 3 months follow-up) were noted. Management of anticoagulant, recurrence rate, mortality and incidence of thromboembolic complications until full recovery were documented. The variables were compared between the group with a history of prior anticoagulation/antiplatelets (AC+, N=97), which was discontinued after diagnosis of the cSDH, and the one without (AC-, N=105) using a t-Test/ Mann Whitney U Test and a Chi square test for categorical variables.

Results: Patients with cSDH and a prior history of anticoagulant had a similar age (77 ± 10 yrs.) compared to those without anticoagulant use (70 ± 15 yrs). There were slightly more male patients in the AC+ group compared to the AC- group (68% vs. 62%). Neither hematoma thickness nor frequency of surgical interventions differed between the two groups. Thromboembolic complications during the further course were significantly more prevalent in the AC+ group (N=12, 12.4% vs. 0%; p < .0001). All fatalities were related to thromboembolism and occurred exclusively in the AC+ group (N=9, 9.3% vs. 0%; p < .001).

Conclusion: So far, there are no specific guidelines for the anticoagulation management inn cSDH. Here, we show that the common habit of anticoagulant/antiplatelet withdrawal results in a higher thromboembolic complication rate and related death Further studies to balance the risk of anticoagulant continuation or withdrawal are required.