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Impact of antithrombotic medications and reversal strategies on the surgical management and outcomes of traumatic acute subdural hematoma.

World Neurosurgery 2023 November 28
OBJECTIVE: Surgical traumatic acute subdural hematoma (aSDH) patients taking antithrombotic medications require careful hematologic management. We sought to compare outcomes between aSDH patients taking antithrombotic medications at admission who received antithrombotic reversal with aSDH patients not taking antithrombotics.

METHODS: Retrospective review identified traumatic aSDH patients requiring surgical evacuation. Our cohort was divided based on antithrombotic use and whether pharmacologic reversal agents or platelet transfusions were administered. A three-way comparison of outcomes was performed between patients taking anticoagulants who received pharmacologic reversal, patients taking antiplatelets who received platelet transfusion, and patients not taking antithrombotics. Multivariable regressions, adjusted for injury severity, further investigated associations with outcomes.

RESULTS: 138 patients met our inclusion criteria. 13.0% (N=18) reported using anticoagulants, 16.7% (N=23) reported using antiplatelets, and 3.6% (N=5) reported using both. Patients taking antiplatelets who received platelet transfusion had longer intra-operative times (P=0.040) and higher rates of palliative care consultations (P=0.046) compared to patients taking anticoagulants who received pharmacologic reversal and patients not taking antithrombotics. Across groups, no significant difference was found in frequencies of in-hospital intracranial hemorrhages and venous thromboembolisms, lengths of hospital stay, rates of inpatient mortality, or follow-up health statuses. In multivariable analysis, intra-operative time remained longest for the antiplatelets with platelet transfusion group. Other outcomes remained non-associated with patient group.

CONCLUSIONS: For surgical traumatic aSDH patients, those taking antiplatelet medications who receive platelet transfusions experience longer intra-operative procedure times and higher rates of palliative care consultation. Comparable outcomes were observed between antithrombotic reversal patients and patients not using antithrombotics.

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