title: Aspirin is associated with an increased risk of subdural hematoma in normal-pressure hydrocephalus patients following shunt implantation.
abstract: OBJECTIVE
  In this paper the authors investigate whether shunt-treated patients with normal-pressure hydrocephalus receiving aspirin therapy are at increased risk of developing subdural hematoma (SDH).
  
  
  METHODS
  Records from 80 consecutive patients who had undergone implantation of a cerebrospinal fluid shunt for the treatment of normal-pressure hydrocephalus were retrospectively reviewed.
  
  
  RESULTS
  Eleven cases of symptomatic SDH occurred, all among patients receiving aspirin or clopidogrel. The 5-year survival estimate was 0.3 (p < 0.0001) for users of aspirin and the hazard ratio was 12.8 (95% CI 3.1-53).
  
  
  CONCLUSIONS
  Patients on an aspirin therapy regimen have a markedly increased risk of SDH after a shunt has been implanted for the treatment of normal-pressure hydrocephalus. Users of clopidogrel may have an even greater risk.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Peter
authors.initials: P
authors.lastname: Birkeland
authors.affiliation: Orthopedic Surgery, Odense University Hospital; and.|Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Lauritsen
authors.affiliation: Departments of 1 Neurosurgery and.|Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Frantz Rom
authors.initials: FR
authors.lastname: Poulsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006408:Hematoma, Subdural / Q000209:etiology*; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D005343:Fibrinolytic Agents; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: NPH = normal-pressure hydrocephalus; SDH = subdural hematoma; aspirin; cerebrospinal fluid shunt; normal-pressure hydrocephalus; subdural hematoma; traumatic brain injury