Masanori Wada1, Iwao Yamakami2, Yoshinori Higuchi3, Mikio Tanaka4, Sumio Suda5, Junichi Ono6, Naokatsu Saeki3. 1. Department of Neurosurgery, Chiba Rehabilitation Center, 1-45-2 Hondacho, Midori-ku, Chiba-shi, Chiba 266-0005, Japan. Electronic address: wadam6222@yahoo.co.jp. 2. Department of Neurosurgery, Chiba Central Medical Center, 1835-1 Kasoricho, Wakaba-ku, Chiba 264-0017, Japan. 3. Department of Neurological Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-0856, Japan. 4. Department of Neurosurgery, Sanmu Medical Center, 167 Naruto, Sanmu-shi, Chiba 289-1326, Japan. 5. Department of Neurosurgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-shi, Chiba 292-8535, Japan. 6. Department of Neurosurgery, Chiba Cardiovascular Center, 575 Tsurumai, Ichihara-shi, Chiba 290-0512, Japan.
Abstract
OBJECTIVE: The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. METHOD: We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. RESULTS: Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. CONCLUSION: Antiplatelet therapy significantly influences the recurrence of CSDH.
OBJECTIVE: The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. METHOD: We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. RESULTS: Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. CONCLUSION: Antiplatelet therapy significantly influences the recurrence of CSDH.