Surgery for Chronic Subdural Hematoma in Patient on Anticoagulant and/or Antiplatelet Drugs

Atef Elmeleigy, Shawky; Abo Elfetouh Abd Elaziz, Eslam; Ahmed Elawady, Moataz; Hammad Eltantawy, Mohamed; Saber Abd Elgawad Mohamed, Mahmoud

doi:10.21608/bmfj.2024.319261.2197

Surgery for Chronic Subdural Hematoma in Patient on Anticoagulant and/or Antiplatelet Drugs

Articles in Press

Document Type : Original Article

Authors

¹ Lecturer of Neurosurgery, Faculty of Medicine, Benha University, Egypt

² Professor of Neurosurgery, Head of neurosurgical department, Faculty of Medicine, Banha University, Egypt

³ Professor of Neurosurgery, Faculty of Medicine, Benha University, Egypt

⁴ MB. B.Ch, Resident of Neurosurgery, Banha University Hospitals

10.21608/bmfj.2024.319261.2197

Abstract

Background: CSDH is a serious fluid collection containing blood that is located between the dura and arachnoid mater. This study aimed to evaluate the suitable timing resulting in the best outcome of surgical evacuation of CSDH in patients on anticoagulant and/or antiplatelet therapy and when to restart these drugs post operatively. Methods: This retrospective cohort study included 300 patients with CSDH on anticoagulant and/or antiplatelet drugs. Detailed history, general and neurological examination, radiological and laboratory investigations were performed. Results: Acute blood accumulation in patients who had urgent intervention more than patients who waited until elimination of effect of anticoagulant or antiplatelets before intervention, but urgent intervention is lifesaving in patient with bad neurological conditions (GCS < 12). Clinical modified Rankin score was significant higher in patients who had urgent intervention compared patients who waited until stabilization before intervention due to risk of bleeding. Delayed recurrence. Conclusion: There are high mortality and morbidity with high risk of acute blood accumulation in early evacuation of CSDH in patients on treated with these drugs. So, if patient neurologically stable (GCS ≥ 12), we can wait until elimination the effect of these drugs. On the other hand, patient with bad neurological conditions (GCS < 12), evacuation of hematoma is a mandatory whatever the general conditions. As regard restoring this medical treatment post-operative, the priority usually for the vital conditions. If it’s life-threatening conditions, we can restore those drugs as early as possible. Otherwise, we can wait as possible result in better outcome.

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