Antithrombotics and recurrence rate following surgery for chronic subdural hematoma

Abstract Background Chronic subdural hematoma (CSDH) is a neurological disorder that is frequent among the elderly. The utilization of antithrombotic agents (AT) has been shown to raise the possibility of developing CSDH. Recently, the clinical treatment of CSDH cases who have either continued or not continued the utilization of AT after surgery depends on anecdotal proof and surgical experience, as there is a lack of quality investigation that explore the topic. Results A retrospective review of our institution’s database for the period from July 2021 till July 2023 yielded 40 consecutive patients who had undergone surgical evacuation of CSDH and were previously on AT. The 1ry endpoint was the recurrence risk among AT consumers. Finally, we investigated whether the timing of continuation of AT therapy, specifically early (within thirty days) versus late prophylactic (more than thirty days) resumption, which includes late prophylactic, event-based, or no resumption (late resumption, later denoted to as simply late resumption), affected the occurrence of thromboembolism or hematoma recurrence. In our study, the mean midline shift for early group was 5.33 mm and the mean midline shift for the late group was 5.14 mm. The mean Glasgow Coma Scale (GCS) for the early group was 13.67 and the mean GCS for the late group was 13.95. There was a statistically insignificant relationship among both groups concerning midline shift and GCS as the P value was more than 0.05. The number of patients reoperated was 2 in early group and was 3 in late group. The number of cases with thromboembolism was 1 in early group and was 4 in late group. There was a statistically insignificant relationship among both groups concerning the thromboembolic event and rate of reoperation as the P value was more than 0.05. Conclusions While early resumption is not related to an elevated possibility of reoperation, it is associated with reduced incidences of thromboembolism. Early resumption of AT treatment appears to be advantageous; however, prospective multi-center research is further required to ascertain the superiority of early resumption in CSDH cases.