Association between postoperative thromboembolic and hemorrhagic complications and clinical outcomes after surgery for chronic subdural hematoma in patients with anticoagulation therapy for atrial fibrillation

IF 1.9 3区医学 Q3 CLINICAL NEUROLOGY Acta Neurochirurgica Pub Date : 2025-01-16 DOI:10.1007/s00701-024-06417-z

Pihla Tommiska, Oula Knuutinen, Kimmo Lönnrot, Riku Kivisaari, Rahul Raj, on behalf of the FINISH study group

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Abstract

Purpose

A substantial proportion of patients undergoing surgery for chronic subdural hematoma (CSDH) use anticoagulation medication due to atrial fibrillation (AF). We assessed the risk of postoperative thromboembolic and hemorrhagic complications in CSDH surgery patients with a history of anticoagulation for AF and their association with outcome.

Methods

This posthoc analysis of a nationwide multicenter randomized controlled trial conducted during 2020–2022 included CSDH patients undergoing surgery with a history of preoperative anticoagulation use for AF. We assessed the incidence of thromboembolic and hemorrhagic complications and their associations with functional outcomes and mortality.

Results

Of 589 patients, 128 patients (median age 83 years, 24% females) were on anticoagulation medication due to AF. The incidences of postoperative thromboembolic and hemorrhagic complications were 8% and 6%, respectively. A significantly higher proportion of patients with a thromboembolic complication had unfavorable functional outcome (70% vs. 21%, p < 0.001) and higher mortality (50% vs. 14%) than those without. After adjusting for risk factors, a thromboembolic complication was independently associated with a higher risk for unfavorable outcome (OR 16.8, 95% CI 3.0–94.2) and death (OR 11.1, 95% CI 2.4–52.0). Similarly, hemorrhagic complications associated independently with unfavorable outcome, although the effect size was smaller than for thromboembolic complications.

Conclusion

The risk for thromboembolic complications seemed to be slightly higher than the risk for postoperative hemorrhagic complications after CSDH surgery in patients with a history of preoperative anticoagulation medication use due to AF. The occurrence of a thromboembolic complication was detrimental for patient prognosis, underscoring the importance of strategies to prevent thromboembolic events. There is an urgent need for a trial assessing the optimal timing of restarting anticoagulation medication after CSDH surgery.

Trial registration

ClinicalTrials.gov identifier NCT04203550.

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房颤抗凝治疗的慢性硬膜下血肿患者术后血栓栓塞和出血并发症与临床结果的关系

目的：在接受慢性硬膜下血肿（CSDH）手术的患者中，有相当一部分患者因房颤（AF）而使用抗凝药物。我们评估了有房颤抗凝史的CSDH手术患者术后血栓栓塞和出血性并发症的风险及其与预后的关系。方法：对2020-2022年期间进行的一项全国性多中心随机对照试验进行事后分析，纳入了术前有房颤抗凝史的CSDH患者。我们评估了血栓栓塞和出血并发症的发生率及其与功能结局和死亡率的关系。结果589例患者中，128例患者（中位年龄83岁，女性24%）因房颤接受抗凝药物治疗，术后血栓栓塞和出血性并发症发生率分别为8%和6%。与没有血栓栓塞并发症的患者相比，有不良功能结局的患者比例明显更高（70%对21%，p < 0.001），死亡率也更高（50%对14%）。在调整了危险因素后，血栓栓塞并发症与较高的不良结局风险（OR 16.8, 95% CI 3.0-94.2）和死亡（OR 11.1, 95% CI 2.4-52.0）独立相关。同样，出血性并发症与不良结局独立相关，尽管效应量小于血栓栓塞性并发症。结论房颤患者术前有抗凝药物使用史的CSDH术后血栓栓塞并发症的风险略高于术后出血并发症的风险，血栓栓塞并发症的发生对患者预后不利，强调预防血栓栓塞事件策略的重要性。迫切需要一项评估CSDH手术后重新开始抗凝药物的最佳时机的试验。临床试验注册clinicaltrials .gov标识符NCT04203550。

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来源期刊

Acta Neurochirurgica 医学-临床神经学

CiteScore

4.40

自引率

4.20%

发文量

342

审稿时长

1 months

期刊介绍： The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.