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Background <p>Chronic subdural hematoma (cSDH) is a common neurosurgical condition in elderly patients, driven by angiogenic and inflammatory membrane activity rather than acute trauma. While burr-hole drainage remains the standard treatment, the timing of postoperative antithrombotic resumption remains heterogeneous. Early restart could prevent thromboembolic complications but may raise concern for recurrence.</p> Methods <p>We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2003–2025), identifying adults undergoing surgical drainage of cSDH. Exposure groups were defined by timing of postoperative antithrombotic therapy: ≤7 days, 8–14 days, 15–28 days, and no therapy within 3 months. Outcomes included 180-day all-cause mortality (primary) and reoperation for recurrence (secondary). Propensity score matching balanced demographics, vascular comorbidities, thromboembolic histories as proxies for indication, and preoperative antithrombotic use.</p> Results <p>Among 11,608 patients, 906 restarted ≤ 7 days, 402 at 8–14 days, 198 at 15–28 days, and 10,102 had no therapy within 3 months. After matching, restart ≤ 7 days was associated with lower mortality versus prolonged non-resumption (18.4% vs. 26.5%; OR 0.62, 95% CI 0.50–0.79; <i>P</i> &lt; 0.001) without higher reoperation (7.8% vs. 9.1%; <i>P</i> = 0.34). Similar mortality associations were observed for restart at 8–14 days (OR 0.68; <i>P</i> = 0.025) and 15–28 days (OR 0.53; <i>P</i> = 0.014). Mortality and reoperation did not differ significantly between ≤ 7 and 8–14 days.</p> Conclusions <p>Postoperative antithrombotic restart within 1 month after cSDH evacuation was associated with lower 180-day mortality without higher recurrence. These findings warrant prospective confirmation incorporating hematoma, surgical, imaging, and indication-specific factors.</p>

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Timing of antithrombotic therapy resumption after surgical evacuation of chronic subdural hematoma: a propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2026年3月31日

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  • Sami Dakhel,
  • Muhammed Amir Essibayi,
  • Ahmed Y. Azzam,
  • Hamza Adel Salim,
  • Hasan Jamil,
  • Huanwen Chen,
  • Dheeraj Gandhi,
  • Adam A. Dmytriw,
  • Vivek S Yedavalli,
  • Marco Colasurdo,
  • Ajay Malhotra,
  • David J Altschul,
  • Dhairya A. Lakhani

摘要

Background

Chronic subdural hematoma (cSDH) is a common neurosurgical condition in elderly patients, driven by angiogenic and inflammatory membrane activity rather than acute trauma. While burr-hole drainage remains the standard treatment, the timing of postoperative antithrombotic resumption remains heterogeneous. Early restart could prevent thromboembolic complications but may raise concern for recurrence.

Methods

We conducted a retrospective cohort study using the TriNetX US Collaborative Network (2003–2025), identifying adults undergoing surgical drainage of cSDH. Exposure groups were defined by timing of postoperative antithrombotic therapy: ≤7 days, 8–14 days, 15–28 days, and no therapy within 3 months. Outcomes included 180-day all-cause mortality (primary) and reoperation for recurrence (secondary). Propensity score matching balanced demographics, vascular comorbidities, thromboembolic histories as proxies for indication, and preoperative antithrombotic use.

Results

Among 11,608 patients, 906 restarted ≤ 7 days, 402 at 8–14 days, 198 at 15–28 days, and 10,102 had no therapy within 3 months. After matching, restart ≤ 7 days was associated with lower mortality versus prolonged non-resumption (18.4% vs. 26.5%; OR 0.62, 95% CI 0.50–0.79; P < 0.001) without higher reoperation (7.8% vs. 9.1%; P = 0.34). Similar mortality associations were observed for restart at 8–14 days (OR 0.68; P = 0.025) and 15–28 days (OR 0.53; P = 0.014). Mortality and reoperation did not differ significantly between ≤ 7 and 8–14 days.

Conclusions

Postoperative antithrombotic restart within 1 month after cSDH evacuation was associated with lower 180-day mortality without higher recurrence. These findings warrant prospective confirmation incorporating hematoma, surgical, imaging, and indication-specific factors.