Evidence map›Paper›PMID 40608194›Full record

SynthesisActa neurochirurgica2025

Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis.

Rahim Abo Kasem, Joshua M Venegas, Ahmed Ibrahim, Zachary S Hubbard, Muhammed Amir Essibayi, Maeen Aldamouni, Mouaz Al-Khalaf, Laith Khokhar, Alejandro M Spiotta

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Rahim Abo KasemDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA. rahimabu99@gmail.com.
Joshua M VenegasDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.
Ahmed IbrahimDepartment of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Zachary S HubbardDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.
Muhammed Amir EssibayiDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Maeen AldamouniFaculty of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
Mouaz Al-KhalafFaculty of Medicine, Damascus University, Damascus, Syria.
Laith KhokharLoyola University, Chicago, IL, USA.
Alejandro M SpiottaDepartment of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC, 29425, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMiddle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear.

methodsA systematic review and meta-analysis were conducted following PRISMA guidelines. Searches of PubMed, Web of Science, Embase, and Scopus through February 28, 2025, identified English-language studies on cSDH treated by MMAE (with or without surgery) reporting AT resumption outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Primary outcomes included recurrence and radiographic measures. Data were pooled using a random-effects model in R software.

resultsOf 514 articles, 3 retrospective studies (233 patients) were included. Among these, 78 resumed AT therapy. Random-effects meta-analysis revealed no significant differences in recurrence (OR 1.64, 95% CI 0.45-6.00, P = 0.45), final SDH thickness (MD: 0.27, 95% CI: -0.91, 1.44, P = 0.66), or reduction in SDH thickness (MD: -0.60, 95% CI: -2.15, 0.96, P = 0.45). Subgroup analyses (antiplatelet vs. anticoagulant, MMAE alone vs. MMAE + surgery, early resumption) also revealed no significant differences. Sensitivity analyses confirmed consistent results. All included studies were moderate-to-high quality.

conclusionResuming AT therapy after cSDH management with MMAE alone or combined with surgery appears not to affect recurrence rates or hematoma resolution. Preliminary findings support the safety of both anticoagulant and antiplatelet agents as well as early resumption. However, larger prospective studies remain essential for confirming these observations and establishing best practices.

Indexed as

Embolization, TherapeuticFibrinolytic AgentsHematoma, Subdural, ChronicMeningeal ArteriesCombined Modality TherapyHumansRecurrenceFibrinolytic AgentsAntithrombotic therapyChronic subdural hematomaMiddle meningeal artery embolizationResumption early

Identifiers

PMID40608194
PMCPMC12226610

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.