Choi, Jongwook
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Pyen, Jinsu
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Cho, Sungmin
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Kim, Jongyeon
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Koo, Younmoo
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
,
Whang, Kum
(Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
Objective : Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have ...
Objective : Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have not yet been clearly identified and studies have reported varying results. Methods : We analyzed 230 patients with CSDH who were treated with burr-hole trephination and drainage at our institution from March 2011 to March 2016. The patients were divided into recurrence and non-recurrence groups and the medical records of each group were used to analyze the risk factors associated with CSDH recurrence. Results : After burr-hole trephination and drainage, CSDH recurrence was observed in 49 (21.3%) of the 230 patients. In univariate analysis, none of the factors showed statistical significance with respect to CSDH recurrence. In multivariate analysis, preoperative antithrombotic medication was the only independent risk factor for CSDH recurrence (odds ratio, 2.407; 95% confidence interval, 1.047-5.531). Conclusion : The present study found that preoperative antithrombotic medication was independently associated with CSDH recurrence.
Objective : Chronic subdural hematoma (CSDH) is one of the most common intracranial hemorrhages. It can be managed with a simple surgical treatment such as burr-hole trephination and drainage. However, it has a relatively high recurrence rate. The mechanisms and risk factors for the recurrence have not yet been clearly identified and studies have reported varying results. Methods : We analyzed 230 patients with CSDH who were treated with burr-hole trephination and drainage at our institution from March 2011 to March 2016. The patients were divided into recurrence and non-recurrence groups and the medical records of each group were used to analyze the risk factors associated with CSDH recurrence. Results : After burr-hole trephination and drainage, CSDH recurrence was observed in 49 (21.3%) of the 230 patients. In univariate analysis, none of the factors showed statistical significance with respect to CSDH recurrence. In multivariate analysis, preoperative antithrombotic medication was the only independent risk factor for CSDH recurrence (odds ratio, 2.407; 95% confidence interval, 1.047-5.531). Conclusion : The present study found that preoperative antithrombotic medication was independently associated with CSDH recurrence.
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가설 설정
Regarding the pathogenesis of CSDH, it is hypothesized that micro-hemorrhage in a hematoma cavity is associated with recurrence. Antithrombotic agents such as antiplatelet medications and anticoagulants are considered to interfere with the formation of clots in these micro-hemorrhages13).
13) reported that DOACs such as dabigatran, edoxaban, apixaban, and rivaroxaban do not increase the recurrence rate of CSDH. The authors argued that there was no need to hesitate while prescribing antithrombotic agents due to fear of CSDH recurrence. In particular, DOACs have a lower risk of cerebral hemorrhage than the vitamin K antagonists17,26).
제안 방법
The purpose of the present study was to analyze the association between the use of antiplatelet or anticoagulant medication and CSDH recurrence in patients at a single institution.
The remaining 230 CSDH patients who underwent surgical treatment were enrolled in this study. These patients were divided into two groups : the recurrence group and the non-recurrence group. Each group was analyzed for past health history (hypertension, diabetes mellitus, chronic alcoholism, and use of antithrombotic agents).
All patients underwent one or two burr-hole trephination surgeries with closed drainage under general anesthesia. After dural incision and hemostasis, the outer hematoma membrane was opened.
All variables were evaluated for association with CSDH recurrence using the two-sample t-test or the chi-squared test. Logistic regression analysis was used to identify the independent risk factors to predict CSDH recurrence and the results were expressed as odds ratio (OR) with 95% confidence interval (CI). Statistical significance was accepted for p values <0.
Other variables showed no statistically significant correlation with recurrence of CSDH in the univariate analysis (Table 2). Binary logistic regression was performed to identify the independent risk factors related to CSDH recurrence. Preoperative antithrombotic medication was observed to be the only independent variable related to CSDH recurrence (OR, 2.
대상 데이터
Thirty-six patients were lost to followup, 11 patients had insufficient medical records, and 11 patients were subjected to reoperation due to insufficient drainage of the initial CSDH. Thus, 56 patients were excluded from the study. The remaining 230 CSDH patients who underwent surgical treatment were enrolled in this study.
Thus, 56 patients were excluded from the study. The remaining 230 CSDH patients who underwent surgical treatment were enrolled in this study. These patients were divided into two groups : the recurrence group and the non-recurrence group.
데이터처리
All variables were evaluated for association with CSDH recurrence using the two-sample t-test or the chi-squared test. Logistic regression analysis was used to identify the independent risk factors to predict CSDH recurrence and the results were expressed as odds ratio (OR) with 95% confidence interval (CI).
성능/효과
7) reported that early (<30 days) resumption of antithrombotic agents are not related to CSDH recurrence and are more beneficial. In this study, because of the limitations of retrospective studies, the timing of antithrombotic agents resumption was not clearly investigated, but in most cases, antithrombotic agents was resumed at least 30 days later.
후속연구
On the other hand, some studies have argued that these benefits of DOACs differ between intracerebral hemorrhage and extracerebral hemorrhage such as subdural and epidural hemorrhage6,26). Further studies are needed to assess the association between DOACs and CSDH outcomes.
Several studies reported that early resumption of antithrombotic agents are not related to CSDH recurrence and are more beneficial, but it may be difficult to generalize the results. The authors plan to conduct further studies on the categorization of antithrombotic agents, and on the optimal timing of resumption of individual subgroups of antithrombotic agents after traumatic brain injury and CSDH.
Therefore, special attention should be paid to patients with a history of receiving antithrombotic medications at the time of CSDH diagnosis in the postoperative follow-up of CSDH patients. Further prospective studies using consistent study design are needed for evaluation of the risk according to each subtype of antithrombotic agents, including DOACs.
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