Introduction: Acute subdural hematoma is a common traumatic brain injury with a relatively high mortality rate. The number of neurosurgical patients on medication that interferes with platelet and coagulation function has increased over the years. However, no studies have focused on the outcome of acute subdural hematoma patients who receive antiplatelet and/or anticoagulant therapy.
Methods: We retrospectively analyzed 15 acute subdural hematoma patients who received antiplatelet and/or anticoagulation therapy prior to craniectomy for hematoma evacuation. Clinical outcome was assessed using the Glasgow outcome score. Patients with good recoveries and moderate disabilities were allocated into the good outcome group, whereas those with severe disabilities and vegetative states or those who died comprised the poor outcome group. Risk factors for functional recovery were evaluated using Fisher’s exact test.
Results: The overall mortality was 25%, with an incidence of postoperative hematoma of 93%. Good outcomes correlated with a preoperative Glasgow coma scale of 9-15(p=0.011), the time from trauma to admission within 4h(p=0.007), the absence of brain herniation(p=0.041), and administration of a single antithrombotic agent(p=0.044).
Conclusions: Acute subdural hematoma patients who received antiplatelet and/or anticoagulant therapy had very poor surgical outcomes and frequent postoperative hematoma. Rapid transfer of acute intracranial hemorrhage patients to the hospital and early surgical decompression (before brain herniation occurs) are critical for good outcomes. Finally, dual antithrombotic agents are strongly associated with poor outcomes.
Patient Care: Good outcomes correlated with a preoperative GCS of 9-15, a time interval from trauma to admission within 4h, absence of brain herniation, and administration of a single antithrom- botic agent. The rapid transfer of traumatic brain injury patients is mandatory. In addition, the physician should be aware that dual antithrombotic therapies are related to poor postoperative outcomes in patients with traumatic SDH.
Learning Objectives: By the conclusion of this session, participants should be able to :1) Good outcomes correlated with a preoperative GCS of 9-15, a time interval from trauma to admission within 4h, absence of brain herniation, and administration of a single antithrom- botic agent.
,2)The rapid transfer of traumatic brain injury patients is mandatory. In addition, the physician should be aware that dual antithrombotic therapies are related to poor postoperative outcomes in patients with traumatic SDH.
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