The possibility of surgery in chronic subdural hematoma associated with the use of antiplatelet or anticoagulant drugs

Objective People take anti-thrombotic agents due to many medical conditions. The aim of this study was to determine whether the use of these drugs affects the likelihood of surgery in patients with chronic subdural hematoma (CSH), with consideration of other factors. Methods This study analyzed clinical and radiological data of 348 patients who were diagnosed with CSH between January 2011 and December 2021. In total, 254 patients were included. We investigated clinical and radiological findings to identify factors that were associated with the likelihood of surgery in CSH. Results Initial Glasgow coma scale (GCS) and radiological factors, such as hematoma thickness, density type, midline shifting, and laterality, were significantly related to the likelihood of surgery (P<0.05). The use of anti-thrombotic drugs in patients with trauma (P=0.043) or chronic alcoholism (P=0.018) was associated with the likelihood of surgery. The use of anti-thrombotic drugs was associated with the density type (P=0.037) of computed tomography scans, but head trauma was not significantly related to the likelihood of surgery. The use of anti-thrombotic drugs was significantly related to the recurrence of CSH (P=0.021). Conclusion This study reported that the initial GCS and several radiological factors were significantly associated with the likelihood of surgery in CSH. Especially in patients taking anti-thrombotic drugs, head trauma or chronic alcoholism was significantly associated with the likelihood of surgery. Close monitoring of these patients is suggested. Keywords: Chronic subdural hematoma; Anti-thrombotic drugs; Head trauma; Alcoholism