Department of Neurosurgery, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg, France.
Department of Neurosurgery, Rouen, France.
Neurochirurgie. 2020 Aug;66(4):195-202. doi: 10.1016/j.neuchi.2020.04.136. Epub 2020 Jul 6.
The management of antithrombotic therapy (AT) after surgery for chronic subdural hematoma (cSDH) requires taking account of the balance of risk between hemorrhage recurrence (HR) and the prophylactic thromboembolic effect (TE). The goal of the present study was to evaluate the prevalence of vascular events (VE: TE and/or HR) in the first 3 postoperative months after cSDH evacuation in patients previously treated by AT. The impact of AT resumption was also evaluated.
This observational prospective multicenter collaborative study (14 French neurosurgery centers) included patients with cSDH treated by AT and operated on between May 2017 and March 2018. Data collection used an e-CRF, and was principally based on an admission questionnaire and outcome/progression at 3 months.
In this cohort of 211 patients, VE occurred in 58 patients (27.5%): HR in 47 (22.3%), TE in 17 (8%), with mixed event in 6 cases (2%). Median overall time to onset of complications 26 days±31.5, and specifically 43.5 days±29.25 for HR. Non-resumption of AT significantly increased the relative risk of VE [OR: 4.14; 95% CI: 2.08 - 8.56; P <0.001] and especially of TE [OR: 7.5; 95% CI: 1.2 - 42; P<0.001]. The relative risk of HR was significantly increased when AT was resumed at less than 30 days (P=0.015).
The occurrence of VE in patients operated on for cSDH and previously treated by AT was statistically significant (27.5%). HR was the most common event (22.3%), whereas TE accounted for only the 8%, although with shorter time to onset. In order to prevent TE risk, AT should be restarted after 30 days, as HR risk is greatly decreased beyond this time.
慢性硬脑膜下血肿（cSDH）手术后抗血栓治疗（AT）的管理需要考虑出血复发（HR）和预防性血栓栓塞（TE）风险之间的平衡。本研究的目的是评估 cSDH 清除术后前 3 个月内曾接受 AT 治疗的患者中血管事件（VE：TE 和/或 HR）的发生率。还评估了 AT 恢复的影响。
这是一项观察性、前瞻性、多中心合作研究（14 家法国神经外科中心），纳入了接受 AT 治疗并于 2017 年 5 月至 2018 年 3 月期间手术治疗的 cSDH 患者。数据采集使用电子病例报告表（e-CRF），主要基于入院问卷和 3 个月时的结果/进展。
在这 211 例患者的队列中，有 58 例（27.5%）发生 VE：HR 47 例（22.3%），TE 17 例（8%），混合事件 6 例（2%）。并发症总发病时间中位数为 26 天±31.5 天，HR 具体为 43.5 天±29.25 天。AT 未恢复显著增加 VE 的相对风险[比值比（OR）：4.14；95%置信区间（CI）：2.08 - 8.56；P <0.001]，尤其是 TE 的相对风险[OR：7.5；95% CI：1.2 - 42；P <0.001]。AT 在 30 天内恢复时，HR 的相对风险显著增加（P=0.015）。
cSDH 手术治疗且曾接受 AT 治疗的患者发生 VE 的发生率具有统计学意义（27.5%）。HR 是最常见的事件（22.3%），而 TE 仅占 8%，尽管发病时间较短。为了预防 TE 风险，AT 应在 30 天后重新开始，因为超过这个时间 HR 风险会大大降低。
