Utility of the aspirin and P2Y12 response assays to determine the effects of antiplatelet agents in patients with subdural hematoma undergoing neurosurgery

Data on the use of reactivity tests in high-risk procedures derive mainly from cardiac surgery but could also have applicability in neurosurgery. Our study aims to evaluate the safety of reactivity tests in patients with surgical indications for chronic subdural hematoma (CSDH). We conducted a case-control study to determine risk factors and outcomes (early-onset complications if they occurred <7 days; late-onset if they occurred >7 days) in patients undergoing evacuation of CSDH recruited in the 2-year period 2022-2024. Patients with a history of antiplatelet treatment and a reactivity test with early negativization (patients in whom the platelet aggregation test became negative before the required suspension period for safely performing the surgical intervention) and an urgent neurosurgical indication were considered cases. Patients who were not taking antiplatelet therapy were considered controls. Complications taken into consideration were cerebral acute subdural hematoma, intraparenchymal hemorrhage, and ischemic complications. We analyzed data from 170 patients who consecutively underwent neurosurgical intervention for CSDH. We enrolled 68 cases who were on antiplatelet therapy before the procedure and showed early negativization on reactivity tests (cases) and 102 controls who were patients who had never been on antiplatelet therapy (controls). We did not observe statistically significant early-onset complications in the case group when compared to the control one (p: 0.64). Regarding late-onset complications, the incidence of total hemorrhagic events was similar in the two study groups (p: 0.14). CSDH is an extremely common condition in the elderly population and in patients on antiplatelet drugs. This condition often requires an urgent neurosurgical intervention, and waiting for antiplatelet treatment to be ineffective could worsen the outcome. Reactivity tests could therefore be a useful and safe tool to guide the timing of neurosurgery and to reduce the hospitalization time.