Timing of Restarting Anticoagulation and Antiplatelet Therapies After Traumatic Subdural Hematoma—A Single Institution Experience

Ryan M. Naylor, Rakan E. Dodin, Katharine A. Henry, Nicole M. De La Peña, Tyler L. Jarvis, Joshua R. Labott, Jamie J. Van Gompel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is a paucity of information regarding the optimal timing of restarting antiplatelet therapy (APT) and anticoagulation therapy (ACT) after traumatic subdural hematoma (tSDH). Therefore, we sought to report our experience at a single level 1 trauma center with regard to restarting APT and/or ACT after tSDH. Methods: A total of 456 consecutive records were reviewed for unplanned hematoma evacuation within 90 days of discharge and thrombotic/thromboembolic events before restarting APT and/or ACT. Results: There was no difference in unplanned hematoma evacuation rate in patients not receiving APT or ACT (control) compared with those necessitating APT and/or ACT (6.4% control, 6.9% APT alone, 5.8% ACT alone, 5.4% APT and ACT). There was an increase in post-tSDH thrombosis/thromboembolism in patients needing to restart ACT (1.9% APT alone, P = 0.53 vs. control; 5.8% ACT alone, P = 0.04 vs. control; 16% APT and ACT; P < 0.001 vs. control). Subgroup analysis revealed that patients with coronary artery disease necessitating APT and patients with atrial fibrillation necessitating ACT had higher thrombosis/thromboembolism rates compared with controls (1.0% control vs. 6.1% coronary artery disease, P = 0.02; 1.0% control vs. 10.1% atrial fibrillation, P < 0.001). The median restart time of ACT was approximately 1 month after trauma; APT was restarted 2–4 weeks after trauma depending on clinical indication. Conclusions: Patients requiring reinitiation of APT and/or ACT after tSDH were at elevated risk of thrombotic/thromboembolic events but not unplanned hematoma evacuation. Therefore, patients should be followed closely until APT and/or ACT are restarted, and consideration for earlier reinitiation of blood thinners should be given on a case-by-case basis.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StateAccepted/In press - 2021

Keywords

  • Anticoagulation
  • Antiplatelet medication
  • Subdural hematoma
  • Thromboembolism
  • Thrombosis
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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