Anticoagulant/antiplatelet therapy and chronic subdural hematoma: a double-center cohort study and a review of knowledge
EANS Academy. Feretos G. 09/25/19; 275806; EP05048
Georgios Feretos
Georgios Feretos

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Chronic subdural hematoma (CSDH) is an increasingly common neurosurgical condition. Risk factors include advancing age, male gender and anticoagulant or antiplatelet use1. From recent studies, approximately 40% of patients with CSDH were on anticoagulant/antiplatelet therapy on admission2. The aim of our research is to evaluate the risk factors of CSDH and especially to assess the correlation between anticoagulant/antiplatelet therapy with CSDH.
We conducted a double-center retrospective cohort study. Age, gender, Glasgow Coma Scale (GCS) and Karnofsky scale on admission, size and location of the subdural hematoma, clinical presentation ,comorbidities, type of the anticoagulant/antiplatelet medication, Glasgow Outcome Scale (GOS) and GCS on discharge, INR and platelet count on admission and discharge, relapse of the CSDH and type of medical intervention (surgery or conservative therapy) were retrieved from the local database systems of the institutes that were included (University General Hospital of Heraklion and General Hospital of Chania). A review of knowledge was performed.
From March 2011 to January 2019, a total of 183 patients were registered (164 patients from University Hospital of Heraklion and 19 patients from General Hospital of Chania). The analysis of the data pointed that 47% of the patients were on anticoagulant/antiplatelet therapy on admission (16,4% on aspirin, 9,8% on warfarin, 8,2% on clopidogrel, 2,7% on heparin, 1,6% on new oral anticoagulants, 4,9% on double-combination therapy). The male:female ratio was 3:1, mean age 76,17 years ,mean INR on admission 1,28 and 84,3% of the patients had a GCS score on admission 14-15/15. 18% of the patients had undergone conservative therapy.
These results support that anticoagulant/antiplatelet therapy may be a predominant factor for the development of CSDH. It is critical for a general practitioner to include CSDH in the differential diagnosis of a patient on anticoagulant/antiplatelet therapy presenting with neurological symptoms.
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