Neurosurgery. 2026 Aug 5. doi: 10.1227/neu.0000000000004183. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVES: Chronic subdural hematomas (cSDH) are among the most common neurosurgical pathologies. Older adults also often have comorbidities treated with anticoagulant and antiplatelet (ACAP) medications. Managing clinicians frequently must weigh the benefits and risks of stopping and reinitiating such drugs in cSDH. The aim of this retrospective study was to analyze outcomes associated with ACAP use and cSDH, focusing on the need for reoperation, mortality, and neurological function.
METHODS: Between 2011 and 2023, patients requiring surgical management of a cSDH across 5 UK neurosurgical units were identified. Collected variables included patient comorbidities, preoperative and postoperative neurological function, ACAP termination and reinitiation, need for reoperation, and mortality. Statistical analysis included multivariable logistic regression for predictors of key outcomes; reoperation, functional status, and mortality including a Kaplan-Meier analysis for reoperation rates based on different ACAP treatments.
RESULTS: One thousand three hundred fifty-five patients underwent analysis, of which 245 were on anticoagulants, 277 were on antiplatelets, 35 were on dual ACAP medications, and 798 were not on any previous ACAP therapy. The median age was 75 years (IQR = 66-83), and the overall reoperation rate was 10.2% (n = 68 on ACAP and n = 70 on no ACAP treatment). Patients on ACAP had higher crude reoperation rates (12.2% vs 8.8%, P = .049), though this difference was not significant after multivariable adjustment (odds ratio = 1.41, 95% CI, 0.77-2.55, P = .272). Discontinuing ACAP treatment for longer preoperatively and later reinitiation did not significantly affect reoperation rates. ACAP patients were generally more comorbid and had significantly worse functional outcomes (modified Rankin Scale 0-2: 52.4% vs 66.4%, adjusted odds ratio = 0.69, 95% CI, 0.53-0.91, P = .007).
CONCLUSION: Preoperative ACAP use and longer preoperative discontinuation are not independently associated with increased reoperation risk in patients with cSDH. Earlier postoperative ACAP reinitiation is also not significantly associated with reoperation risk. However, more extensive large scale prospective studies are required to support these findings and form clinical recommendations.
PMID:42554463 | DOI:10.1227/neu.0000000000004183
