Abboud Tammam, Dührsen Lasse, Gibbert Christina, Westphal Manfred, Martens Tobias
University Medical Center Göttingen, Department of Neurosurgery, Germany; University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Germany.
University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Germany.
Neurocirugia (Astur : Engl Ed). 2018 Mar-Apr;29(2):86-92. doi: 10.1016/j.neucir.2017.09.006. Epub 2017 Nov 6.
Chronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH.
A cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6.
201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p=0.001 and p=0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence.
Administration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort.
慢性硬膜下血肿（cSDH）是神经外科实践中常见的病症，尤其是在经常需要使用抗血栓药物的老年患者中。本研究的目的是调查抗血栓药物对接受cSDH手术患者的复发率和临床结局的影响。
回顾性分析在一个中心5年内接受cSDH手术的一组患者。从患者病历中获取症状表现、凝血检测、抗血栓药物使用史和合并症情况。标准神经外科手术是在局部麻醉下进行单孔钻孔并插入硬膜下引流管。使用改良Rankin量表（mRS）通过问卷调查和电话访谈来评估临床结局。良好结局定义为mRS 0至3，不良结局定义为mRS 4至6。
201例cSDH患者接受了初始手术治疗并纳入研究。中位随访时间为81周。41例患者（20.4%）服用抗血小板药物，43例患者（21.4%）服用苯丙香豆素。37例患者（18.4%）因血肿复发需要再次手术。36例患者（17.9%）出现不良结局。年龄较大和入院时服用苯丙香豆素均是预测不良结局的独立危险因素（分别为p = 0.001和p = 0.031）。抗血栓药物的使用对血肿复发无影响。
服用苯丙香豆素和年龄较大可能会增加cSDH患者出现不良结局的风险。在我们的患者队列中，服用苯丙香豆素和抗血小板药物均未影响硬膜下血肿的复发率。
