The Potential Role of Drug-Drug Interactions in the Pathophysiology and Prognosis of Chronic Subdural Hematoma

Abstract Chronic subdural hematoma (cSDH) is a common neurosurgical condition, but its pathophysiology remains incompletely understood. Drug-drug interactions (DDIs) occur when one medication alters the effects of another. To determine the frequency of DDIs with potential bleeding risk in patients with cSDH and to explore their association with the clinical outcomes. The current single-center, retrospective study included 55 patients with cSDH. Data on regular medications and drugs used within the preceding 2 months were obtained from the hospital's electronic database. Statistical analyses were performed using the R software (free and open source), version 4.5.2. The continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range, IQR) values, and the categorical variables, as numbers (percentages). Group comparisons were performed using the Mann–Whitney U and Fisher's exact tests. Firth's penalized logistic regression adjusted for age was used to evaluate the associations involving DDI burden and adverse outcomes. The study included 55 patients. The mean number of medications per patient was of 5.6 ± 3.25, and 33 subjects (60.0%) had a history of anticoagulant or antiplatelet therapy. Drug-drug interactions with the potential to increase bleeding risk were identified in 38 patients (69.1%). Major morbidity occurred more frequently in patients with DDIs than in those without them (21.1% versus 0.0% respectively; p = 0.048). Drug-drug interactions with the potential to impair coagulation were identified in nearly 70% of the patients with cSDH. These interactions may represent an underrecognized factor contributing to the development and recurrence of cSDH, and they may be associated with worse clinical outcomes.