Adele Mazzoleni, Jamie F M Brannigan, Munashe Veremu, Youssef Chedid, William H Cook, Matthew L Watson, Keng Siang Lee, Orla Mantle, Vian Omar, Marwan Al-Munaer, Alexandra Lisitsyna, Githmi Palahepitiya Gamage, Alvaro Yanez Touzet, Gideon Adegboyega, Edward Goacher, Oliver Mowforth, Conor S Gillespie, Ellie Edlmann, Daniel J Stubbs, Benjamin M Davies
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引用次数: 0
Abstract
Background: Chronic subdural haematoma (CSDH) is common in the elderly, with approximately 40% of patients with CSDH taking anti-thrombotic medications. Surgery necessitates temporary cessation. The optimal time of postoperative antithrombotic resumption is not known, with the risk of recurrence balanced against the risk of thrombosis.
Methods: A systematic review was carried out (registration number:CRD42023427275). Medline and EMBASE databases were searched. The primary outcome of this study was recurrence. Late and early resumption was defined by study authors - a final definition was not possible given the heterogeneity amongst papers.
Results: 7 studies were included in the final analysis (3,195 patients total). Generally, studies reported higher risk of thromboembolic events in patients in late resumption groups (n = 4). On meta-analysis, there was no increased risk of recurrence in the early vs late groups (OR 0.61, 95% CI [0.016; 2.40], I2 = 0%, p = 0.26). Most studies reported that early resumption was not associated with increased adverse events. Definitions of early and late varied by study (earliest range <3 days to <30 days).
Conclusions: We found no significant difference in rates of recurrence, or thromboembolic events in those receiving early or late resumption of antithrombotic medication. Prospective studies with consensus definitions are required to inform clinical decision making and guidelines.
期刊介绍:
The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide.
Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.