1087 The Safety and Feasibility of Early Resumption of Anticoagulation Following Middle Meningeal Artery Embolization in Patients with Subacute Subdural Hematomas

INTRODUCTION: Managing anticoagulation(AC) therapy in patients with subacute or chronic subdural hematomas(SDHs) poses a considerable challenge, balancing the risk of hemorrhagic expansion against the potential for thromboembolic events. Middle meningeal artery(MMA) embolization presents a therapeutic opportunity to stabilize SDHs. Without clear guidelines, the decision to resume AC after embolization is fraught with uncertainties, particularly concerning the safety of such a strategy. METHODS: A single-center, retrospective review was conducted on the medical records of patients undergoing MMA embolization for subacute or chronic SDHs while on AC therapy. The study assessed the feasibility and safety of early AC resumption post-embolization, focusing on clinical outcomes. RESULTS: 21 patients on AC underwent MMA embolization for acute or chronic SDH at our institution from 2020-2023. The average time to resume anticoagulant therapy was 7.69 days±13.52, and to resume antiplatelet therapy was 10.50 days±10.42. One patient required surgical intervention post-MMA embolization, while six had prior interventions. Within 90 days post MMA embolization, two patients were readmitted for SDH recurrence. Both patients had multiple vascular risk factors, and one patient was restarted on anticoagulant therapy 0 days post-MMA embolization and had SDH recurrence 72 days after discharge. In contrast, the second patient restarted 50 days post-MMA embolization and had SDH recurrence seven days after initial discharge. CONCLUSIONS: Early resumption of AC therapy following MMA embolization appears to be safe for most patients with SDHs, with only one case of SDH recurrence in those whose AC therapy was restarted early and one case of recurrence in a patient whose AC therapy was being held until 50 days post-MMA embolization. These findings highlight the need for further research to guide optimal antithrombotic therapy management in this population.