Antiplatelet Medication and Operative Subdural Hematomas: A Retrospective Cohort Study Evaluating Reoperation Rates.
Antiplatelet
Intracranial hemorrhage
Platelet transfusion
Reoperation
Subdural hematoma
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
09
11
2018
revised:
15
01
2019
accepted:
17
01
2019
pubmed:
9
2
2019
medline:
21
12
2019
entrez:
9
2
2019
Statut:
ppublish
Résumé
Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined. We performed a retrospective review of consecutive patients treated with craniotomy or craniectomy for evacuation of an acute or mixed-density SDH between 2012 and 2017 at 2 academic institutions. Exclusion criteria included anticoagulant therapy, thrombocytopenia, and/or international normalized ratio >1.3. Clinical and radiographic data were collected; primary endpoint was reoperation within 30 days. Logistic regression models were used to identify predictors of reoperation. A total of 195 patients were included: 86 patients on antiplatelet medication and 109 with no antithrombotic history. Overall, 24 (12.3%) of patients required a reoperation. Reoperation rate in patients on antiplatelet medication was not significantly different than those not on antithrombotics (14.0% vs. 11.0%, P = 0.53). Patients taking antiplatelet medication were significantly older, more likely to have medical comorbidities, and more likely to receive preoperative platelet transfusion (36.0% vs. 3.7%, P < 0.001). Of patients taking antiplatelet medications, there was no difference in reoperation rate between those patients receiving preoperative platelet transfusion and those not receiving transfusion (16.1% vs. 12.7%, P = 0.75). Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.
Sections du résumé
BACKGROUND
Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined.
METHODS
We performed a retrospective review of consecutive patients treated with craniotomy or craniectomy for evacuation of an acute or mixed-density SDH between 2012 and 2017 at 2 academic institutions. Exclusion criteria included anticoagulant therapy, thrombocytopenia, and/or international normalized ratio >1.3. Clinical and radiographic data were collected; primary endpoint was reoperation within 30 days. Logistic regression models were used to identify predictors of reoperation.
RESULTS
A total of 195 patients were included: 86 patients on antiplatelet medication and 109 with no antithrombotic history. Overall, 24 (12.3%) of patients required a reoperation. Reoperation rate in patients on antiplatelet medication was not significantly different than those not on antithrombotics (14.0% vs. 11.0%, P = 0.53). Patients taking antiplatelet medication were significantly older, more likely to have medical comorbidities, and more likely to receive preoperative platelet transfusion (36.0% vs. 3.7%, P < 0.001). Of patients taking antiplatelet medications, there was no difference in reoperation rate between those patients receiving preoperative platelet transfusion and those not receiving transfusion (16.1% vs. 12.7%, P = 0.75).
CONCLUSIONS
Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.
Identifiants
pubmed: 30735874
pii: S1878-8750(19)30251-7
doi: 10.1016/j.wneu.2019.01.151
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e671-e677Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.