Evaluation of clinical outcome and predictive factors for thromboembolism or hemorrhagic complications in patients treated for chronic subdural hematoma. A prospective observational study

The impact of anticoagulant and antiplatelet medications on clinical outcome and risk of complications is uncertain in chronic subdural hematoma (CSDH) patients. Currently, evidence-based guidelines and specific neurosurgical scores lacks. CHA₂DS₂-VASc and HAS-BLED scores have been proven to help predicting complications in the perioperative period of non-cardiac surgeries. We performed a multicenter prospective observational trial to evaluate the clinical outcomes and complications of CSDH patient undergoing surgery, comparing patients taking anticoagulant/antiplatelet (AAPT) and not (NT). Additionally, we investigated the role of CHA₂DS₂-VASc and HAS-BLED scores in predicting thromboembolic events or hemorrhages. No associations have been found between AAPT and clinical outcomes of patients. Emergency surgery was not a significant factor in improving outcomes. Post-operative hemorrhages were more frequent in the AAPT group, but none required a second surgery. A significant higher risk of of new bleedings was found in the ASA group with discontinuation ≤ 5 days. A higher HAS-BLED score was not associated with a worse clinical outcome. A 1-point increase in CHA₂DS₂-VASc was associated with a lower probability of favorable outcomes at 1 month. 90% of AAPT and 44% of NT patients were at moderate-high risk of thromboembolic events based on CHA₂DS₂-VASc score, with no difference in incidence between groups. The use of AAPT does not influence outcomes, complication rates, or recurrence in patients undergoing surgery for CSDH. Scores such as CHA₂DS₂-VASc or HAS-BLED could aid in stratifying bleeding and thromboembolic risks and in the management of these drugs in the perioperative period.