TY - JOUR
T1 - Time to resumption of antithrombotic therapy in chronic subdural haematoma
T2 - a systematic review and meta-analysis
AU - On Behalf Of The ICENI Clinical Practice Guidelines For Chronic Subdural Haematoma Consortia
AU - Mazzoleni, Adele
AU - Brannigan, Jamie F.M.
AU - Veremu, Munashe
AU - Chedid, Youssef
AU - Cook, William H.
AU - Watson, Matthew L.
AU - Lee, Keng Siang
AU - Mantle, Orla
AU - Omar, Vian
AU - Al-Munaer, Marwan
AU - Lisitsyna, Alexandra
AU - Gamage, Githmi Palahepitiya
AU - Yanez Touzet, Alvaro
AU - Adegboyega, Gideon
AU - Goacher, Edward
AU - Mowforth, Oliver
AU - Gillespie, Conor S.
AU - Edlmann, Ellie
AU - Stubbs, Daniel J.
AU - Davies, Benjamin M.
N1 - Publisher Copyright:
© 2025 The Neurosurgical Foundation.
PY - 2025/7/16
Y1 - 2025/7/16
N2 - Background: Chronic subdural haematoma (CSDH) is common in the elderly, with approximately 40% of patients with CSDH taking anti-thrombotic medications. Surgery necessitates temporary cessation. The optimal time of postoperative antithrombotic resumption is not known, with the risk of recurrence balanced against the risk of thrombosis. Methods: A systematic review was carried out (registration number:CRD42023427275). Medline and EMBASE databases were searched. The primary outcome of this study was recurrence. Late and early resumption was defined by study authors - a final definition was not possible given the heterogeneity amongst papers. Results: 7 studies were included in the final analysis (3,195 patients total). Generally, studies reported higher risk of thromboembolic events in patients in late resumption groups (n = 4). On meta-analysis, there was no increased risk of recurrence in the early vs late groups (OR 0.61, 95% CI [0.016; 2.40], I2 = 0%, p = 0.26). Most studies reported that early resumption was not associated with increased adverse events. Definitions of early and late varied by study (earliest range <3 days to <30 days). Conclusions: We found no significant difference in rates of recurrence, or thromboembolic events in those receiving early or late resumption of antithrombotic medication. Prospective studies with consensus definitions are required to inform clinical decision making and guidelines.
AB - Background: Chronic subdural haematoma (CSDH) is common in the elderly, with approximately 40% of patients with CSDH taking anti-thrombotic medications. Surgery necessitates temporary cessation. The optimal time of postoperative antithrombotic resumption is not known, with the risk of recurrence balanced against the risk of thrombosis. Methods: A systematic review was carried out (registration number:CRD42023427275). Medline and EMBASE databases were searched. The primary outcome of this study was recurrence. Late and early resumption was defined by study authors - a final definition was not possible given the heterogeneity amongst papers. Results: 7 studies were included in the final analysis (3,195 patients total). Generally, studies reported higher risk of thromboembolic events in patients in late resumption groups (n = 4). On meta-analysis, there was no increased risk of recurrence in the early vs late groups (OR 0.61, 95% CI [0.016; 2.40], I2 = 0%, p = 0.26). Most studies reported that early resumption was not associated with increased adverse events. Definitions of early and late varied by study (earliest range <3 days to <30 days). Conclusions: We found no significant difference in rates of recurrence, or thromboembolic events in those receiving early or late resumption of antithrombotic medication. Prospective studies with consensus definitions are required to inform clinical decision making and guidelines.
KW - anticoagulation
KW - chronic subdural haematoma
KW - neurosurgery
UR - https://www.scopus.com/pages/publications/105012482744
U2 - 10.1080/02688697.2025.2523021
DO - 10.1080/02688697.2025.2523021
M3 - Article
C2 - 40667837
AN - SCOPUS:105012482744
SN - 0268-8697
JO - British Journal of Neurosurgery
JF - British Journal of Neurosurgery
ER -