title: Optimal perioperative management of antithrombotic agents in patients with chronic subdural hematoma.
abstract: OBJECTIVE
  The use of antithrombotic agents such as anticoagulants and antiplatelet agents is widespread, and the opportunities to treat patients with chronic subdural hematoma (CSDH) under antithrombotic therapy are growing. However, whether antithrombotic therapy contributes to postoperative complications and recurrences of CSDH and how these agents should be managed in the surgical treatment of CSDH remains unclear.
  
  
  METHODS
  We retrospectively analyzed 150 consecutive patients with CSDH who underwent neurosurgical interventions at Kyushu Rosai Hospital from 2011 to 2015 and followed them for more than 3 months.
  
  
  RESULTS
  Of the 150 study patients, 44 received antithrombotic therapy. All anticoagulants and 76% of the antiplatelet agents were discontinued before surgical treatment of CSDH and resumed within 1 week except in 4 patients whose treatment was terminated and 7 patients who developed postoperative complications or underwent reoperations before resumption of these agents. Postoperative hemorrhagic complications associated with surgical treatment of CSDH occurred in 8 patients (5.3%), and there was no significant difference in the incidence of these complications between patients with and without antithrombotic therapy (6.8% vs. 4.7%, respectively; p=0.90). Postoperative thromboembolic complications occurred in 5 patients (5.4%), including 4 patients with antithrombotic therapy; these complications developed before resumption of antithrombotic agents in 2 patients. There was a significant difference in the incidence of postoperative thromboembolic complications between patients with and without antithrombotic therapy (9.1% vs. 0.9%, respectively; p=0.04). There were no significant differences in the incidence of radiographic deterioration or reoperation of ipsilateral or contralateral hematomas between patients with and without antithrombotic therapy after surgical treatment of unilateral CSDH.
  
  
  CONCLUSIONS
  A history of antithrombotic therapy was significantly correlated with the incidence of postoperative thromboembolic complications in patients with CSDH. Antithrombotic agents should be resumed as soon as possible when no hemorrhagic complication is confirmed after neurosurgical intervention for CSDH.
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan. Electronic address: amano@ns.med.kyushu-u.ac.jp.
authors: Toshiyuki
authors: T
authors: Amano
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan.
authors: Kenta
authors: K
authors: Takahara
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan; Department of Neurosurgery, Hamanomachi Hospital, Fukuoka, Japan.
authors: Naoki
authors: N
authors: Maehara
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Takafumi
authors: T
authors: Shimogawa
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Nobutaka
authors: N
authors: Mukae
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tetsuro
authors: T
authors: Sayama
authors: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Fukuoka, Japan.
authors: Shoji
authors: S
authors: Arihiro
authors: Department of Cerebrovascular Disease, Kyushu Rosai Hospital, Fukuoka, Japan; Stroke Cener, Steel Memorial Yawata Hospital, Fukuoka, Japan.
authors: Shuji
authors: S
authors: Arakawa
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan; Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan.
authors: Takato
authors: T
authors: Morioka
authors: Department of Neurosurgery, Kyushu Rosai Hospital, Fukuoka, Japan.
authors: Sei
authors: S
authors: Haga
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000139:chemically induced*
chemical_list: D005343:Fibrinolytic Agents
keywords: Antithrombotic therapy; Chronic subdural hematoma; Perioperative management; Postoperative complication; Recurrence