Introduction: Chronic subdural hematomas (cSDH) are particularly common in older adults who have increased risk of falls and the conditions that require anticoagulants (ACs). In such cases, clinicians are often left with the dilemma of comanaging the cSDH and the ongoing need for ACs.
Methods: Patients who underwent surgical interventions for cSDH at our institution between January 2006 and June 2022 were identified. Propensity score matched analysis was used to make a balance in patients on AC before procedure vs those who were not on AC and patients on AC post-procedure vs those who were not. Length of hospitalization, peri-procedural complications, reintervention rate during the same admission, rebleeding risk and reintervention rates after discharge were compared.
Results: In total, 104 patients were on long-term AC before a procedure, while 372 were not. After matching, 55 pairs were included in the analysis. Post-procedure, 74 patients were started on long-term AC, the rest were not. Then 49 patients in each group were included in the analysis after matching. Comparing the pre-procedure AC group with non-AC group, no significant differences were found in length of hospitalization (8.5± 6.7 vs 8.1 ± 7.7, p=0.75), periprocedural complications (7.3% vs 7.3%, p=1), or reintervention during the same admission (1.8% vs 5.5%, p=0.31). In the comparison of post-procedure AC group and non-AC group, no significant differences were seen in recurrence rate (8.2% vs 12.2%, p=0.74), reintervention rate after discharge (4.1% vs 14.3%, p=0.16), or disability, mRS<=2, (83.7% vs 89.8%, p=.55).
Conclusion : Being on long-term AC before cSDH procedures does not affect length of hospitalization, peri-procedural complications, or reintervention during the same admission. Similarly, long-term AC after cSDH treatment does not increase recurrence or reintervention rate. It appears safe to restart patients on AC after surgical treatment of cSDH.
