Do anticoagulant and antiplatelet drugs exert local effects in chronic subdural hematoma expansion?
Authors:
B. Ertuğrul 1; A. C. Ergün 2; M. Kaplan 1; H. Kömürcü 1; S. Tanyıldızı 3; G. Dağoğlu 3
Authors‘ workplace:
Department of Neurosurgery, Firat University Faculty of Medicine, Elazığ, Türkiye
1; Department of Neurosurgery, Elazığ Fethi Sekin City Hospital, Elazığ, Türkiye
2; Department of Pharmacology and Toxicology, Firat University Faculty of Veterinary Medicine, Elazığ, Türkiye
3
Published in:
Cesk Slov Neurol N 2026; 89(4): 263-266
Category:
Original Paper
doi:
https://doi.org/10.48095/cccsnn2026263
Overview
Introduction: Chronic subdural hematoma is a frequent neurosurgical condition often linked to anticoagulant and antiplatelet therapy. Whether these agents exert local biochemical effects on hematoma expansion is unclear. This study examined the presence of active metabolites of acetylsalicylic acid, warfarin, clopidogrel, and enoxaparin in hematoma fluid and capsule tissue obtained during burr-hole surgery. Materials and methods: A prospective observational study included 42 patients (25 males, 17 females; mean age 68.5 years) who underwent burr-hole drainage without discontinuation of anticoagulant or antiplatelet therapy. Hematoma fluid and capsule samples were collected intraoperatively and analyzed by high-performance liquid chromatography. Results: Patients were on acetylsalicylic acid (N = 12), warfarin (N = 8), clopidogrel (N = 6), enoxaparin (N = 7), or the combination of acetylsalicylic acid and clopidogrel (N = 9). None of the active metabolites were detected in any hematoma fluid or capsule sample. No intraoperative complications occurred. Conclusion: Anticoagulant and antiplatelet agents are recognized systemic risk factors in chronic subdural hematoma development and progression. However, this study found no evidence of local accumulation within hematoma tissue. The results indicate that their role in chronic subdural hematoma pathogenesis is mediated through systemic hemostatic mechanisms rather than local biochemical effects.
Keywords:
chronický subdurální hematom – antikoagulační léčba – protidestičková léčba – zvětšení hematomu – vysokoúčinná kapalinová chromatografi e
Sources
1. Markwalder TM. Chronic subdural hematomas: a review. Neurosurgery 1981; 54 : 637–645.
2. Torihashi K, Sadamasa N, Yoshida K. Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 2008; 63 : 1125–1129. doi: 10.1227/01.NEU.0000335782.60059.17.
3. Kan P, Fiorella D, Dabus G et al. ARISE I consensus statement on the management of chronic subdural hematoma. Stroke 2024; 55 (5): 1438–1448. doi: 10.1161/STROKEAHA.123.044129.
4. von Elm E, Altman DG, Egger M et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. BMJ 2007; 335 (7624): 806–808. doi: 10.1016/j.jclinepi.2007.11.008.
5. Yamashima T, Yamamoto S. How do vessels proliferate in the capsule of a chronic subdural hematoma? Neurosurgery 1984; 15 : 672–678. doi: 10.1227/00006123-198411000-00006.
6. Yadav YR, Parihar V, Namdev H et al. Chronic subdural hematoma. Asian J Neurosurg 2016; 11 (4): 330–342.
7. Asan Z. Growth potential of subdural hematomas under clinical observation: which subdural hematomas tend to grow and why they do. World Neurosurg 2018; 113: e598–e603.
8. Liu W, Bakker NA, Groen RJM. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg 2014; 121 : 665–673. doi: 10.3171/2014.5.JNS132715.
9. Shim YS, Park CO, Hyun DK et al. What are the causative factors for a slow, progressive enlargement of a chronic subdural hematoma? Yonsei Med J 2007; 48 : 210–217. doi: 10.3349/ymj.2007.48.2.210.
10. Safain MG, Roguski M, Antoniou A et al. A single--center experience with the bedside subdural evacuating port system: a useful alternative for chronic subdural hematoma evacuation. J Neurosurg 2013; 118 : 694–700. doi: 10.3171/2012.11.JNS12689.
11. Poon MTC, Rea C, Kolias AG et al. Influence of antiplatelet and anticoagulant drug use on outcomes after chronic subdural hematoma drainage. J Neurotrauma 2021; 38 (8): 1177–1184. doi: 10.1089/neu.2018.6080.
12. Liu E, Tilbury N, Morin T et al. Antiplatelet and anticoagulation use and outcomes following chronic subdural hematoma drainage: systematic review and meta-analysis. World Neurosurg 2026; 208 : 124873. doi: 10.1016/j.wneu.2026.124873.
13. Bumpetch D, Sitthinamsuwan B, Nunta-Aree S. A prospective study of the effect and safety of atorvastatin on the recurrence of chronic subdural hematoma after burr hole surgery. Asian J Neurosurg 2023; 18 (3): 567–572. doi: 10.1055/s-0043-1771372.
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
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