gms | German Medical Science

Objective: Toanalyze our institutional experience with anticoagulants and platelet inhibitors in patients with CSDH. Furthermore, we used a computer assisted volumetric analysis to identify possible additional predictors for recurrent hematoma.

Methods: Pertinent data from all patients (n=335) treated for CSDH in our Department from 2014-2016 were collected from the hospital's database. Medical history, neurologic deficits and use of anticoagulants and/or platelet inhibitors was documented in addition to various clinical parameters. Pre- and postoperative imaging data was acquired from the hospital's network for volumetric analysis using a well-established computer software. The impact of these drugs and various clinical and volumetric parameters were tested for possible correlation with recurrence rate. Statistical analysis was performed using standard methods.

Results: 225 males and 110 females at a median age of 78 yrs. were included. 43.3% were located on the left, 32.5% on the right side and 24.1% had bilateral CSDH. Only 66.9% reported a trauma and 64.1% presented with deficits. 51.9% were on at least one blood- thinning agent (31.7% anticoagulants, 25.1% platelet inhibitors, 2.4% modern anticoagulants). Surgery was performed in 95.5% of cases (92.4% burr hole). Recurrence rate was 12.3%. Mortality was at 4.9% (only 0.9% related to CSDH). The volumetric analysis revealed higher recurrence rate and mortality if residual hematoma was > 40% the preoperative volume (p=0.02 & 0.03). Residual hematoma < 40 cm3 reduced recurrence rate significantly (p=0.02). Blood-thinning agents had no significant impact on recurrence rate but resulted in higher initial CSDH volume (p=0.01).

Conclusion: Recurrence rate after CSDH surgery is mainly determined by volume reduction and residual hematoma. Notably, blood-thinning agents are widespread but only increase the primary hematoma volume without influencing recurrence rate.