Institute of Clinical Medicine - Neurosurgery, University of Eastern Finland, Kuopio, Finland.
Neurocenter - Neurosurgery, Kuopio University Hospital, Kuopio, Finland.
Acta Neurochir (Wien). 2022 Oct;164(10):2699-2708. doi: 10.1007/s00701-022-05337-0. Epub 2022 Aug 16.
To study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH).
A retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years.
A total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013-3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089-5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events.
ATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.
研究抗血栓治疗（ATT）对手术治疗慢性硬脑膜下血肿（CSDH）患者预后的影响。
本研究为来自芬兰东部的回顾性基于人群的队列研究，纳入 2016 年至 2017 年间接受颅骨钻孔引流术（BHC）治疗 CSDH 的所有成年患者。复发的随访时间为 6 个月，死亡率的随访时间为 3 年。
共纳入 301 例 CSDH 患者。164 例（54.5%）患者在诊断时使用 ATT（抗血栓治疗；抗血小板或抗凝药物）。102 例（33.9%）患者血肿为双侧。47 例（15.8%）患者出现血肿复发。双侧 CSDH 比单侧血肿更常需要再次手术（12.6%比 22.0%；p=0.036），无论初次手术（单侧或双侧）如何。二元逻辑回归分析显示，双侧血肿（OR 1.918；95%CI 1.013-3.630；p=0.045）和男性（OR 2.363；95%CI 1.089-5.128；p=0.030）独立预测血肿复发。总体 3 年死亡率为 27.9%。ATT 的使用与 CSDH 复发无关，并且临时术后 ATT 停药时间的长短与血栓栓塞事件的发生率无关。
在我们的研究人群中，ATT 并不影响 CSDH 的复发，并且临时术后 ATT 停药时间的长短与血栓栓塞并发症的发生率无关。男性和双侧血肿与复发的关系更为密切。
