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Clinical Research
DOI: 10.1016/j.neucir.2017.09.006
Influence of antithrombotic agents on recurrence rate and clinical outcome in patients operated for chronic subdural hematoma
Influencia de los agentes anti-trombóticos en la tasa de recidiva y el resultado clínico en los pacientes operados de hematoma subdural crónico
Tammam Abbouda,b,1,
Corresponding author
tammamabboud@gmail.com

Corresponding author.
, Lasse Dührsenb,1, Christina Gibbertb,c, Manfred Westphalb, Tobias Martensb
a University Medical Center Göttingen, Department of Neurosurgery, Germany
b University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Germany
c Medical Center Eilbek, Department of Spine Surgery, Germany
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Received 20 June 2017, Accepted 12 September 2017
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Table 1. Patients characteristics, comorbidities and recurrence rates according to the administration of antithrombotic agents.
Table 2. Predictive factors of poor outcome in patients with cSDH.
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Abstract
Introduction

Chronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH.

Methods

A cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6.

Results

201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p=0.001 and p=0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence.

Conclusion

Administration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort.

Keywords:
Chronic subdural hematoma
Recurrent hematoma
Antiplatelet drug
Anticoagulant drug
Phenprocoumon
Resumen
Introducción

El hematoma subdural crónico (HSC) es una enfermedad común en la práctica neuro-quirúgica, especialmente en pacientes mayores, quienes requieren con frecuencia agentes anti-trombóticos. El objetivo de este estudio fue investigar la influencia de los agentes anti-trombóticos en las tasas de recidiva y los resultados clínicos en los pacientes operados de HSC.

Métodos

Se analizó retrospectivamente una cohorte de pacientes operados de HSC en un único centro, durante un periodo de 5 años. Se obtuvieron de las historias de los pacientes los síntomas de presentación, las pruebas de coagulación, el historial de agentes anti-trombóticos y las comorbilidades. El procedimiento quirúrgico estándar consistió en una trepanación bajo anestesia local, con inserción de un drenaje subdural. Se utilizaron cuestionarios y entrevistas telefónicas para valorar el resultado clínico mediante la Escala de Rankin modificada (mRS). El resultado favorable se definió como el valor de 0 a 3 de mRS, y el resultado desfavorable el valor de 4 a 6.

Resultados

Doscientos uno pacientes con HSC fueron sometidos a tratamiento quirúrgico inicial, y fueron incluidos en el estudio. El seguimiento medio fue de 81 semanas. A 41 pacientes (20,4%) se les administró tratamiento anti-plaquetario y a 43 (21,4%) fenprocumón. El hematoma recurrente requirió cirugía en 37 pacientes (18,4%). Se observaron resultados desfavorables en 36 pacientes (17,9%). La avanzada edad y la administración de fenprocumón al ingreso resultaron factores predictivos independientes del resultado desfavorable (p=0,001 y p=0,031, respectivamente). La administración de agentes anti-trombóticos no tuvo impacto sobre la recidiva del hematoma.

Conclusión

La administración de fenprocumón y la edad avanzada pueden incrementar el riesgo de resultado desfavorable en los pacientes con HSC. Ni la administración de fenprocumón ni la de fármacos anti-plaquetarios influyeron en la tasa de hematomas subdurales en nuestra cohorte de pacientes.

Palabras clave:
Hematoma subdural crónico
Hematoma recurrente
Fármacos anti-plaquetarios
Fármacos anti-coagulantes
Fenprocumón

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