Impact of discontinuation of antithrombotic therapy after surgery for chronic subdural hematoma - 14/09/20
Impact de l’interruption des antithrombotiques après traitement chirurgicale de l’hématome sous dural chronique
, F.-X. Ferracci b, T. Metayer c, B. Gouges d, H.-A. Leroy d, N. Hamdam e, N. Bougaci f, A. De Barros g, A. Timofeev h, P.-H. Pretat i, M. Bannwarth j, P. Roblot k, C. Peltier l, M. Lleu m, B. Pommier n, S. Chibbaro a, F. Proust a, H. Cebula aBienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
Introduction |
The management of antithrombotic therapy (AT) after surgery for chronic subdural hematoma (cSDH) requires taking account of the balance of risk between hemorrhage recurrence (HR) and the prophylactic thromboembolic effect (TE). The goal of the present study was to evaluate the prevalence of vascular events (VE: TE and/or HR) in the first 3 postoperative months after cSDH evacuation in patients previously treated by AT. The impact of AT resumption was also evaluated.
Patients and methods |
This observational prospective multicenter collaborative study (14 French neurosurgery centers) included patients with cSDH treated by AT and operated on between May 2017 and March 2018. Data collection used an e-CRF, and was principally based on an admission questionnaire and outcome/progression at 3 months.
Results |
In this cohort of 211 patients, VE occurred in 58 patients (27.5%): HR in 47 (22.3%), TE in 17 (8%), with mixed event in 6 cases (2%). Median overall time to onset of complications 26 days±31.5, and specifically 43.5 days±29.25 for HR. Non-resumption of AT significantly increased the relative risk of VE [OR: 4.14; 95% CI: 2.08 - 8.56; P <0.001] and especially of TE [OR: 7.5; 95% CI: 1.2 - 42; P<0.001]. The relative risk of HR was significantly increased when AT was resumed at less than 30 days (P=0.015).
Conclusion |
The occurrence of VE in patients operated on for cSDH and previously treated by AT was statistically significant (27.5%). HR was the most common event (22.3%), whereas TE accounted for only the 8%, although with shorter time to onset. In order to prevent TE risk, AT should be restarted after 30 days, as HR risk is greatly decreased beyond this time.
Le texte complet de cet article est disponible en PDF.Keywords : Anticoagulant, Antiplatelet therapy, Antithrombotic, Chronic subdural hematoma, Vascular disorders, Thromboembolism
Abreviations : Chronic subdural hematoma, Antithrombotic therapy, Thromboembolic event, Hemorrhagic recurrence, Vascular event, Antiplatelet therapy, Anticoagulant, Case Report Form, New oral anticoagulants, Vitamin K antagonist, Low molecular weight heparin, Prothrombin Ratio, Activated partial thromboplastin time, Deep venous thrombosis, Pulmonary embolism, Odds ratio, Prothrombin complex concentrate, Transient ischemic attack
Plan
Vol 66 - N° 4
P. 195-202 - août 2020 Retour au numéro
Article précédent
- Impact de la pandémie COVID-19 sur la neurochirurgie pédiatrique en France
- F. Di Rocco, D. Scavarda, M. Vinchon, A. Szathmari, L. Riffaud, A. Bohra, T. Blauwblomme, S. Boetto, E. Gimbert, S. Ferrand, A. Coca, N. Chivoret, G. Coll, M. Delion, T. Roujeau, C. Mottolese, M. Zerah, Société française de neurochirurgie pédiatrique
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