Timing of Low-Dose Aspirin Discontinuation for chronic subdural hematoma

Anticoagulant and antiplatelets therapies increase the risk for both occurrence and chronic subdural hematoma recurrence 1) 2) 3) 4) 5) 6)

These drugs are generally used for first and secondary prevention of thrombotic-embolic events, especially in elderly people. Guidelines recommend 5-7 days of acetylsalicylic acid (ASA) suspension to perform a safer surgery 7) 8).

Indeed, often the neurologic deterioration of the patients does not allow to wait the recommended time for surgery. Even if the antiplatelet effect would be rationally associated with an increased morbidity and mortality in patients with a CSDH, this is not uniquely demonstrated in literature. Only few studies assessed the risks of antiplatelets in the surgical management of CSDHs

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Kamenova M, Nevzati E, Lutz K, et al. Burr-hole drainage for chronic subdural hematoma under low-dose acetylsalicylic acid: a comparative risk analysis study. World Neurosurg. 2017;100:594-600.
Guha D, Coyne S, Macdonald RL. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg. 2016;124:750-759.
Poon MTC, Rea C, Kolias AG, Brennan PM. British Neurosurgical Trainee Research Collaborative (BNTRC). Influence of antiplatelet and anticoagulant drug use on outcomes after chronic subdural hematoma drainage [e-pub ahead of print]. J Neurotrauma. 2019. https://doi.org/ 10.1089/neu.2018.6080, accessed May 15, 2019.
Scerrati A, Mangiola A, Rigoni F, et al. Do antiplatelet and anticoagulant drugs modify outcome of patients treated for chronic subdural hematoma? Still a controversial issue [e-pub ahead of print]. J Neurosurg Sci. 2019. https://doi.org/ 10.23736/S0390-5616.18.04311-4, accessed May 15, 2019.
Mehta V, Harward SC, Sankey EW, Nayar G, Codd PJ. Evidence based diagnosis and management of chronic subdural hematoma: a review of the literature. J Clin Neurosci. 2018;50:7-15.
Macdonald RL. Management of intracranial hemorrhage in the anticoagulated patient. Neurosurg Clin N Am. 2018;29:605-613.
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  • Last modified: 2020/04/25 10:31
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