Impact of antithrombotic agents on outcomes in patients requiring surgery for chronic subdural haematoma: a systematic review and meta-analysis
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Le résumé fourni par la source
A chronic subdural haematoma (CSDH) is a collection of aged blood between the dura and the brain, typically treated with surgical evacuation. Many patients with CSDH have comorbidities requiring the use of antithrombotic medications. The optimal management of these medications in the context of CSDH remains unknown, as the risk of recurrence must be carefully weighed against the risk of vaso-occlusive events. To better understand these risks and inform the development of clinical practice guidelines, we conducted a systematic review and meta-analysis. A systematic review was conducted in accordance with the PRISMA guidelines, searching Medline and Embase databases. The study was registered with PROSPERO (CRD42023397061). A total of 44 studies were included, encompassing 1 prospective cohort study and 43 retrospective cohort studies. Pooled odds ratios (ORs) were calculated for CSDH recurrence and vaso-occlusive events in patients taking anticoagulant or antiplatelet medications compared to patients not receiving antithrombotic therapy. GRADE was used to assess the quality of evidence. In patients on anticoagulant therapy at CSDH diagnosis, the pooled OR for CSDH recurrence was 1.41 (95% CI 1.11 to 1.79; I2 = 28%). For patients on antiplatelet therapy, the pooled OR was 1.31 (95% CI 1.08 to 1.58; I2 = 32%). Patients taking antithrombotic medications had a significantly higher risk of vaso-occlusive events, with a pooled OR of 3.74 (95% CI 2.12 to 6.60; I2 = 0%). There was insufficient evidence to assess the impact of time to recommence antithrombotic medication on CSDH outcomes. We found that baseline antithrombotic use is associated with the risk of CSDH recurrence and vaso-occlusive events following surgical evacuation. The evidence base is of low quality, and decisions regarding antithrombotic therapy should be individualised for each patient. Further high-quality, prospective studies or registry-based designs are needed to better inform clinical decision-making and establish evidence-based guidelines.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Impact of antithrombotic agents on outcomes in patients requiring surgery for chronic subdural haematoma: a systematic review and meta-analysis
- Date Crossref
- 08/04/2024
- Éditeur
- Informa UK Limited
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Oxford Nuffield Department of Clinical Neurosciences pays non établi dans la noticeUniversité ou école supérieure
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University of Cambridge Department of Clinical Neurosciences pays non établi dans la noticeUniversité ou école supérieure
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Addenbrooke's Hospital pays non établi dans la noticeÉtablissement de santé
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University of Bristol pays non établi dans la noticeUniversité ou école supérieure
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Sheffield Teaching Hospitals NHS Foundation Trust pays non établi dans la noticeOrganisme public
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University of Sheffield pays non établi dans la noticeUniversité ou école supérieure
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King's College Hospital pays non établi dans la noticeÉtablissement de santé
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University of Buckingham pays non établi dans la noticeUniversité ou école supérieure
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Royal College of Surgeons in Ireland pays non établi dans la noticeUniversité ou école supérieure
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University of Manchester pays non établi dans la noticeUniversité ou école supérieure
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Cambridge University Hospitals NHS Foundation Trust Addenbrookes Hospital pays non établi dans la noticeOrganisme public
Nuffield Department of Clinical Neurosciences — University of Oxford, Department of Clinical Neurosciences — University of Cambridge et Addenbrooke's Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.