DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20172538

Effect of antiplatelet/anticoagulant agents in elderly patients of chronic subdural hematoma: a case control study from a tertiary care centre

Nilesh Vishnu Potdar, Suresh Kumar S., Bhavadasan Kaplinghat

Abstract


Background: Bleedings are well known risks of both antiplatelet and anticoagulant therapy and both therapies have historically been considered as risk factors for CSDH. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma (CSDH).

Methods: Single institution case-control study was conducted in patients older than 60 years who visited our academic tertiary care Emergency Department from January 2012 to December 2016. Patients with CSDH were identified by review of case and controls were selected with a 1:3 ratio for gender, age (60 years), year of admission and recent trauma.

Results: There were 124 cases and 372 controls included in the study. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 1.22 (CI 95% 0.66-1.54) and 1.12 (CI 95% 0.68-1.54), respectively. While OR was 1.11 (CI 95% 0.54-2.32), 1.21 (CI 95% 0.61-2.45), and 0.53 (CI 95% 0.33-0.78) for patients receiving oral anticoagulants, ADP-antagonists, and Cox-inhibitors, respectively. History of recent trauma was an effective modifier of the association between anticoagulants and CSDH. OR of 1.69 (CI 95% 0.99-2.96) was found for patients with history of trauma and OR of 4.27 (CI 95% 2.23-8.32) for patients without history of trauma.

Conclusions: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association appears even stronger in those patients under anticoagulant therapy, who develop a CSDH in the absence of a recent trauma.

 


Keywords


Anticoagulant, ADP-antagonists, Antiplatelet agents, Chronic subdural haematoma, Trauma

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References


Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatr. 2003;74:937-43.

Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ. The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg. 2008;22:529-34.

Ramachandran R, Hegde T. Chronic subdural hematomas-causes of morbidity and mortality. Surg Neurol. 2007;67:367-72.

Lo WL, Lee TC, Fang PS, Huang YH. Chronic subdural hematoma in patients under age 65 years: A comparative study of age cohort. Formos J Surg. 2013;46(1):4-10.

Arpino L, Gravina M, Basile D, Franco A. Spontaneous chronic subdural hematoma in a young adult. J Neurosurg Sci. 2009;53(2):7-55.

Lee KS. Natural history of chronic subdural haematoma. Brain Inj. 2004;18(4):351-8.

Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single center cohort study. Neurosurg Rev. 2004;27:263-6.

Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial haemorrhage. Facts and hypotheses. Stroke. 1995;26(8):1471-7.

Lindvall P, Koskinen LO. Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clin

Neurosci. 2009;16:1287-90.

Reymond MA, Marbet G, Radu EW, Gratzl O. Aspirin as a risk factor for haemorrhage in patients with head injuries. Neurosurg Rev. 1992;15:21-5.

Rust T, Kiemer N, Erasmus A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci. 2006;13:823-7.

McQuaid KR, Laine L. Systematic review and meta-analysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med. 2006;119:624-38.

Flaherty ML, Kissela B, Woo D, Kleindorfer D, Alwell K, Sekar P, et al. The increasing incidence of anticoagulant-associated intracerebral haemorrhage. Neurol. 2007;68(2):116-21.

Stroobandt G, Fransen P, Thauvoy C, Menard E. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Acta Neurochir. 1995;137:6-14.