Keywords
chronic subdural hematoma
outcome
hematoma volume
How to Cite
Abstract
Background: Chronic subdural hematoma (CSDH) is one of the commonest conditions encountered in neurosurgical practice. It is a disease more commonly seen in the elderly, and its incidence is expected to rise as the population of persons above 65 years increases. With improving survival and an increasing ageing population, the use of antithrombotic medications to prevent and treat cardiovascular diseases appears to be on the rise. Though trauma is the leading cause of CSDH, these pharmacologic agents alter coagulation and have been associated with the rising recurrence of CSDH. There appears to be a complex relationship between CSDH and coagulopathy, which can lead to rebleeding or recurrence after surgical evacuation of the hematoma.
Aim/Objectives: To determine the relationship between the presence of coagulopathy and outcome in patients who underwent burr hole drainage of CSDH.
Methodology: This was a retrospective cohort study on all patients who underwent drainage of CSDH at the University of Benin Teaching Hospital over a 19-year period from June 2006 to May 2025. Clinical data were obtained from a computerised log of patients' records and analysed using STATA software version 12.
Results: One hundred and forty patients were studied. The male-to-female ratio was 4:1, and most patients were above 60 years (55.5%). Fifty-one per cent (51%) had coagulopathy - 10.07% were on antiplatelet medications and 0.71% were on warfarin. Seventy-two per cent (72%) of patients with coagulopathy had a history of trauma. Bilateral CSDH was found in thirty-six per cent (36%) of patients with coagulopathy. The patients who had coagulopathy had lower mean hematoma volumes, longer hospital stay, and accounted for all the patients (4) who required ICU admission. The presence of coagulopathy did not alter the rate of recurrence, reoperation, and GOS at discharge.
Conclusion: There is a high incidence of coagulopathy in patients who have CSDH, and most of them would require prompt evacuation irrespective of haematoma volume. Pre- and post-operative substitution of coagulation factors is associated with very good outcomes despite poor neurological status at presentation.
