Recurrence in 787 Patients with Chronic Subdural Hematoma: Retrospective Cohort Investigation of Associated Factors Including Direct Oral Anticoagulant Use

Objective: Chronic subdural hematoma (CSDH) is a highly recurrent disorder. Although some predictors including the use of antithrombotic agents such as aspirin and warfarin have been proposed, the pathogenic mechanism involved remains unclear. Moreover, the link between direct oral anticoagulant (DOAC) agent use and CSDH recurrence has not been reported. The aim of this study was to investigate factors including DOAC use that could potentially be associated with CSDH recurrence. Methods: The authors analyzed 787 patients with CSDH who underwent surgery for CSDH with 1 burr-hole irrigation at Baba Memorial Hospital from January 2012 to November 2017. The patients were divided into recurrence and nonrecurrence groups and anticoagulant, antiplatelet, and control groups. Recurrence was defined as ipsilateral hemorrhage within 90 days from the original operation. Variables with P < 0.1 in the univariate analysis were included in a multivariate logistic regression model. Results: CSDH recurrence was observed in 12.2% of patients, and significantly more men (80.2%) than women experienced recurrence. Age, sex, and warfarin use were entered in the multivariate analysis, and it was revealed that age and male sex were independently associated with CSDH recurrence. Antithrombotic agent use including use of DOACs was not associated with increased CSDH recurrence. Conclusions: The present study found that age and male sex were independently associated with CSDH recurrence, while the use of antithrombotic agents was not.