The safety and feasibility of anticoagulant resumption following middle meningeal artery embolization in patients with subacute subdural hematomas

BackgroundManaging antithrombotic therapy (AT), including anticoagulants and antiplatelet agents, 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 AT after embolization is fraught with uncertainties. This article evaluates the safety of resuming AT after MMA embolization in patients with subacute or chronic SDHs.MethodsA single-center, retrospective study of patients undergoing MMA embolization for subacute or chronic SDHs while on AT was conducted, focusing on clinical outcomes.ResultsTwenty-one patients on AT underwent MMA embolization for subacute or chronic SDH at our institution between 2020 and 2023. The average time to resume anticoagulation therapy was 7.69 ± 13.52 days, and antiplatelet therapy was resumed at an average of 10.50 ± 10.42 days post-procedure. One patient required surgical intervention post-MMA embolization. Within 90 days post-embolization, two patients were readmitted for SDH recurrence. Only one of these recurrences occurred after the resumption of AT, and this patient had a coagulopathy disorder. The second patient's recurrence was not attributed to AT, as it was restarted after the recurrence.ConclusionResumption of AT following MMA embolization appears to be safe for most patients with SDHs, with only one recurrence observed in patients restarted on AT post-procedure, and this patient had a coagulopathy disorder. These findings highlight the need for further research to guide optimal management in this population.