Time to resumption of antithrombotic therapy in chronic subdural haematoma: a systematic review and meta-analysis.

IF 1 4区 医学 Q4 CLINICAL NEUROLOGY
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.

慢性硬膜下血肿恢复抗血栓治疗的时间:系统回顾和荟萃分析。
背景:慢性硬膜下血肿(CSDH)在老年人中很常见,大约40%的CSDH患者服用抗血栓药物。手术需要暂时停止。术后抗血栓恢复的最佳时间尚不清楚,复发风险与血栓形成风险相平衡。方法:进行系统评价(注册号:CRD42023427275)。检索Medline和EMBASE数据库。这项研究的主要结果是复发。晚期和早期恢复由研究作者定义-鉴于论文的异质性,不可能给出最终定义。结果:最终分析纳入7项研究,共3195例患者。一般来说,研究报告了晚恢复组患者发生血栓栓塞事件的风险更高(n = 4)。在荟萃分析中,早期组与晚期组的复发风险没有增加(OR 0.61, 95% CI [0.016;2.40], I2 = 0%, p = 0.26)。大多数研究报告早期恢复与不良事件增加无关。早期和晚期的定义因研究的早期范围而异。结论:我们发现早期或晚期恢复抗栓药物的患者在复发率或血栓栓塞事件方面没有显著差异。需要具有共识定义的前瞻性研究来为临床决策和指南提供信息。
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来源期刊
British Journal of Neurosurgery
British Journal of Neurosurgery 医学-临床神经学
CiteScore
2.30
自引率
9.10%
发文量
139
审稿时长
3-8 weeks
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.
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