Textbook of Neuroanesthesia and Neurocritical Care by Hemanshu Prabhakar & Zulfiqar Ali

Author:Hemanshu Prabhakar & Zulfiqar Ali
Language: eng
Format: epub
ISBN: 9789811333903
Publisher: Springer Singapore

16.2.3.2 Subdural Hematoma Risk with Antithrombotic Medications

The incidence of subdural hematomas (Fig. 16.3) has been on the rise since the 1980s, likely due to an aging population and the increased prevalence of patients receiving antithrombotic agents [115]. A Danish population-based study of over 10,000 patients found an incremental risk in the incidence of SDH with use of low-dose aspirin (adjusted OR, 1.24 [95% CI, 1.15–1.33]), clopidogrel (adjusted OR, 1.87 [95% CI, 1.57–2.24]), DOAC (adjusted OR, 1.73 [95% CI, 1.31– 2.28]), or VKA (adjusted OR, 3.69 [95% CI, 3.38–4.03]). The combination of a low-dose aspirin and a VKA (adjusted OR, 4.00 [95% CI, 3.40–4.70]) or clopidogrel and a VKA (adjusted OR, 7.93 [95% CI, 4.49–14.02]) resulted in the highest risk of SDH compared to no antithrombotic agent use [115]. The prevalence of antithrombotic drug use increased from 31.0 per 1000 individuals from the general population in 2000 to 76.9 per 1000 individuals in 2015 (p < 0.001 for trend). The overall incidence of SDH increased from 10.9 per 100,000 in 2000 to 19.0 per 100,000 in 2015. The largest increase was among older patients, with a near doubling over the same time period: from 55.1 to 99.7 per 100,000 person-years (p < 0.001 for trend).

Fig. 16.3A 73-year-old patient who fell while on systemic anticoagulation. Left panel. Right-sided subdural hematoma with midline shift of >5 mm. Right panel. Head CT immediately after right decompressive hemicraniectomy. Note improvement in midline shift after decompression.

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