Postoperative acute subdural hematoma in patients with chronic subdural hematoma due to antithrombotic therapy

AIM To evaluate the relationship between the time from termination of anticoagulant/antiplatelet medication to surgery and the risk of acute postoperative hemorrhage in CSDH patients. MATERIAL AND METHODS A retrospective study of patients who underwent bur hole craniotomy for CSDH between December 2014 and December 2019 was performed. Demographic and clinical data of age, gender, medication (antithrombotic therapy), smoking, daily alcohol consumption, history of head trauma, presenting symptoms and neurological examination were collected from medical records. Patients were divided into 3 groups according to the time of surgery from referral; 1st group: within 24 hours; 2nd group: between 24 to 72 hours; 3rd group: after 72 hours. RESULTS In the 5-year period, 117 patients underwent CSDH surgery. 72 of 117 patients were male (61.5%) and 45 of 117 patients were female (38.5%). The mean age was 70.5 ± 7.2 years. Postoperative ASDH was observed in 2 of 32 patients (6.3%) without any antithrombotic medication history and 6 of 85 patients (7.1%) with previous antithrombotic medication history. Preoperative antithrombotic drug usage was not statistically significant in terms of acute complication development (p = 0.797). CONCLUSION In this study, we found that the risk of acute hemorrhage due to antithrombotic medication did not differ from those who were not under the medication. Although it is reported in the literature that antiaggregant and anticoagulant drugs should be discontinued between 5 and 7 days before the surgical procedure, our results showed that acute hemorrhage was not detected in any of the patients operated 72 hours after referral.