Clinical Course and Results of Surgery for Chronic Subdural Hematomas in Patients on Drugs Affecting Hemostasis.

OBJECTIVE: An apparent increase of use of drugs affecting hemostasis in our neurosurgical department since the 1990s has encouraged us to investigate whether these drugs influence the clinical course and results of surgery for chronic subdural hematoma (CSDH).

METHODS: This retrospective analysis included 178 patients admitted for CSDH from 2007 to 2011 who were divided into two groups: on drugs affecting hemostasis (40; 22%) and no bleeding disorders (138; 78%). Medications in the first group included oral anticoagulants (33; 82.5%), antiplatelets (5; 12.5%) and low molecular weight heparins (2; 5%).

RESULTS: The patients on drugs affecting hemostasis were older (74.3±7.4 vs. 68.4±14.8; p -value 0.01) and the group without bleeding disorders had more head trauma history (61% vs. 38%, p -value 0.01). The groups did not differ in bilateral hematoma rates (25% vs. 20%, p -value=NS). At diagnosis, mean hematoma thickness was lower in patients on drugs affecting hemostasis (18.7±7.4 mm vs. 21.9±7.9 mm, p -value<0.01). Average stay of hospital was 1 day longer in patients on drugs affecting hemostasis (11.7±4.1 vs.10.9±5.3, p -value=NS) and was related to the necessity of bleeding disorder reversal. Mean neurological status at presentation was similar between the groups ( p -value=NS) as was the likelihood of hematoma recurrence ( p -value=NS). Glasgow Outcome Scale results were comparable.

CONCLUSION: Patients on drugs affecting hemostasis are less often aware of a head trauma history, possibly suggesting a higher CSDH risk after minor trauma in this group. In these patients, smaller hematomas are symptomatic, probably due to faster hematoma formation. Drugs affecting hemostasis do not affect treatment results.