抗血栓薬服用例における慢性硬膜下血腫の治療経験

抄録

To determine the influence of antithrombotic (anticoagulant and antiplatelet) agents on patients with chronic subdural hematoma (CSDH), the authors retrospectively analyzed 103 patients with CSDH who underwent surgical treatment for CSDH at our institution from January 1998 through June 2011. Of theses 103 patients, 18 patients received antithrombotic agents (warfarin in 10 patients and aspirin in 8), and were com­pared with 85 other patients who did not take antithrombotic agents. All patients were treated with burr hole irrigation, drainage, or irrigation with drainage. Warfarin was restarted 3 weeks after the surgical treatment. Cessation of aspirin was needed for up to 2 weeks prior to surgery. None of the 18 patients had a recurrence and their outcomes were comparable to the patients who did not take antithrombotic agents. One patient who discontinued warfarin died of acute myocardial infarction three days after surgery.

Discontinuation of warfarin for 3 weeks after surgery may result in a low probability of CSDH recurrence and aspirin could be restarted early after surgery under careful perioperative management.