Evidence map›Paper›PMID 41912884›Full record

ArticleNeurosurgical review2026

Timing of antithrombotic therapy resumption after surgical evacuation of chronic subdural hematoma: a propensity score-matched analysis.

Sami Dakhel, Muhammed Amir Essibayi, Ahmed Y Azzam, Hamza Adel Salim, Hasan Jamil, Huanwen Chen, Dheeraj Gandhi, Adam A Dmytriw, Vivek S Yedavalli, Marco Colasurdo and 3 more

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Article in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Sami Dakhel *Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, USA.
Muhammed Amir Essibayi *Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Ahmed Y AzzamASIDE Healthcare, Lewes, Delaware, USA.
Hamza Adel SalimDepartment of Neuroradiology, MD Anderson Medical Center, Houston, TX, 77030, USA.
Hasan JamilGraduate School of Public Health, St. Luke's International University, Tokyo, Japan.
Huanwen ChenDivision of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA.
Dheeraj GandhiDivision of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA.
Adam A DmytriwNeuroendovascular Program, Women's Hospital, Massachusetts General Hospital & Brigham, Harvard University, Boston, MA, USA.
Vivek S YedavalliDepartment of Radiology, Johns Hopkins University, Baltimore, MD, USA.
Marco ColasurdoDepartment of Interventional Radiology, Oregon Health & Science University, Portland, OR, USA.
Ajay MalhotraDepartment of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA.
David J AltschulDepartment of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Dhairya A LakhaniDepartment of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA. dhairyalakhani@gmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic subdural hematoma (cSDH) is a common neurosurgical condition in elderly patients, driven by angiogenic and inflammatory membrane activity rather than acute trauma. While burr-hole drainage remains the standard treatment, the timing of postoperative antithrombotic resumption remains heterogeneous. Early restart could prevent thromboembolic complications but may raise concern for recurrence.

methodsWe conducted a retrospective cohort study using the TriNetX US Collaborative Network (2003–2025), identifying adults undergoing surgical drainage of cSDH. Exposure groups were defined by timing of postoperative antithrombotic therapy: ≤7 days, 8–14 days, 15–28 days, and no therapy within 3 months. Outcomes included 180-day all-cause mortality (primary) and reoperation for recurrence (secondary). Propensity score matching balanced demographics, vascular comorbidities, thromboembolic histories as proxies for indication, and preoperative antithrombotic use.

resultsAmong 11,608 patients, 906 restarted ≤ 7 days, 402 at 8–14 days, 198 at 15–28 days, and 10,102 had no therapy within 3 months. After matching, restart ≤ 7 days was associated with lower mortality versus prolonged non-resumption (18.4% vs. 26.5%; OR 0.62, 95% CI 0.50–0.79; P < 0.001) without higher reoperation (7.8% vs. 9.1%; P = 0.34). Similar mortality associations were observed for restart at 8–14 days (OR 0.68; P = 0.025) and 15–28 days (OR 0.53; P = 0.014). Mortality and reoperation did not differ significantly between ≤ 7 and 8–14 days.

conclusionsPostoperative antithrombotic restart within 1 month after cSDH evacuation was associated with lower 180-day mortality without higher recurrence. These findings warrant prospective confirmation incorporating hematoma, surgical, imaging, and indication-specific factors.

Indexed as

Fibrinolytic AgentsHematoma, Subdural, ChronicAgedAged, 80 and overDrainageFemaleHumansMaleMiddle AgedPropensity ScoreReoperationRetrospective StudiesTime FactorsTreatment OutcomeFibrinolytic AgentsAnticoagulantAntiplateletAntithromboticChronicEmbolizationSubdural hematomaSurgeryTiming

Identifiers

PMID41912884

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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.