Background: CSDH is a serious fluid collection containing
blood that is located between the dura and arachnoid mater. This
study aimed to evaluate the suitable timing resulting in the best
outcome of surgical evacuation of CSDH in patients on
anticoagulant and/or antiplatelet therapy and when to restart
these drugs post operatively. Methods: This retrospective cohort
study included 300 patients with CSDH on anticoagulant and/or
antiplatelet drugs. Detailed history, general and neurological
examination, radiological and laboratory investigations were
performed. Results: Acute blood accumulation in patients who
had urgent intervention more than patients who waited until
elimination of effect of anticoagulant or antiplatelets before
intervention, but urgent intervention is lifesaving in patient with
bad neurological conditions (GCS < 12). Clinical modified
Rankin score was significant higher in patients who had urgent
intervention compared patients who waited until stabilization
before intervention due to risk of bleeding. Delayed recurrence.
Conclusion: There is high mortality and morbidity with high risk
of acute blood accumulation in early evacuation of CSDH in
patients on treated with these drugs. So, if patient neurologically
stable (GCS ≥ 12), we can wait until elimination the effect of
these drugs. On the other hand, patient with bad neurological
conditions (GCS < 12), evacuation of hematoma is a mandatory
whatever the general conditions. As regard restoring this medical
treatment post-operative, the priority usually for the vital
conditions. If it’s life-threatening conditions, we can restore
those drugs as early as possible. Otherwise, we can wait as
possible result in better outcome. |
