Resumption of Antithrombotic Therapy and the Operative Procedure in Recurrent Chronic Subdural Hematoma

Eighty-two consecutive patients with chronic subdural hematoma (CSDH) were treated by burr hole craniostomy and closed system drainage with (irrigation drainage [ID] ) or without irrigation (simple drainage [SD] ) of the hematoma cavity. Patients were divided into an ID group (n=46) and an SD group (n=36). We compared the postoperative recurrence rates between the ID and SD groups, taking notice of the perioperative antithrombotic therapy (ATT). Recurrence occurred in 14 patients (25.9%) in the ID group and in 5 (12.8%) in the SD group, but the difference was not statistically significant. In the ID group, the recurrence rate of patients whose anticoagulants were restarted within 2 weeks after operation was significantly higher than that of patients who were not or had never been anti-coagulated (p=0.049). In the SD group, the recurrence rate did not increase regardless of postoperative early resumption of anticoagulants. Compared to the ID procedure, the influence of postoperative antithrombotic therapy seemed to be lower on the patients treated by the SD procedure. For the patients receiving ATT, the SD procedure might be useful to avoid not only the increasing risk of thromboembolic complication due to discontinuation of antithrombotic agents (ATA) but also the increasing risk of hematoma recurrence due to early resumption of ATA.