Urokinase Salvage Therapy for Recurrent Chronic Subdural Hematoma Caused by Dual Antiplatelet Therapy

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical conditions among older adults. Here, we describe a case of recurrent cSDH resulting from seven days of dual antiplatelet therapy. A 76-year-old woman reported a headache resembling a chronic tension-type headache for the last 10 days. MRI revealed a right parietal cSDH and left frontoparietal cSDH. Single burr-hole aspiration and irrigation technique with continuous closed subdural drainage was performed bilaterally under general anesthesia. The patient experienced two bouts of transient ischemic attack and received seven days of dual antiplatelet therapy. On the 12th day after the initial surgery, the patient underwent another operation to re-evacuate the cSDH. Considering that the color of the output fluid persisted as oil-black and the average net output was 12.5 cc/day, we decided to use urokinase to restore the patency of the drainage catheter. In the early postoperative phase after the second surgery, a total of 20,000 units of urokinase was injected into the subdural space. On the 10th postoperative day, the patient was discharged home. In patients with cSDH presenting with obvious postoperative hematoma residue, the routine use of subdural injection of urokinase could be a new direction in cSDH management.