The effects of antithrombotic drugs on the recurrence and mortality in patients with chronic subdural hematoma: A meta-analysis

OBJECTIVES: Chronic subdural hematoma (cSDH) is a common neurological disorder in elderly and the immediate outcome of surgery is satisfied. The high reoperation rate hinders the long-term effect of surgery and the risk factor is still unclear. Some researchers reported that high recurrence rate is related to the antithrombotic (AT) drugs, which is commonly used to prevent diseases in elderly patients. In this article, we conducted a meta-analysis to determine whether AT agents increase the risk of recurrence and mortality in patients with cSDH. METHODS: The human case–control or randomized controlled trial (RCT) studies regarding the association of cSDH and AT were systematically identified through online databases (PubMed, Cochrane, Web of Science, Elsevier Science Direct, and Springer Link). Inclusion and exclusion criteria were defined for the eligible studies. The fixed-effects model was performed when homogeneity was indicated. RESULTS: This meta-analysis included 24 studies. AT drugs significantly increased the risk of recurrence in patients with cSDH (odds ratio (OR) of 1.30, 95% confidence interval (CI), 1.11–1.52, P = .001). Further analysis demonstrated that both anticoagulation (OR of 1.41, 95% CI, 1.10–1.81, P = .006) and antiplatelet (OR of 1.23, 95% CI, 1.01–1.49, P = .03) had higher risk of recurrence, but no difference was found between them (OR of 0.80, 95% CI, 0.58–1.09, P = .16). However AT drugs did not increase the risk of mortality for patients with cSDH (OR of 1.08, 95% CI, 0.61–1.92, P = .78). CONCLUSION: AT treatment is an important risk factor of recurrence in patients with cSDH in spite of similar mortality rate. When and how to resume AT drugs is still unclear, more well-designed prospective researches are needed on this issue. CORE TIP: High recurrence is an important factor against the long-term outcome of surgery in patients with cSDH, the use of AT drugs is a potential risk factor. In this study we found that the use of AT drugs increased the risk of recurrence rather than mortality. Anticoagulation and antiplatelet showed no difference in causing cSDH recurrence.