Risk Benefit Analysis of Restarting Antithrombotic Medications After Middle Meningeal Artery Embolization in Chronic Subdural Hematoma
Year: 2026
Type: article
Abstract: BACKGROUND AND OBJECTIVES: Middle meningeal artery (MMA) embolization is used in chronic subdural hematoma (cSDH). The safety of resuming antithrombotic (AT) therapy after MMA embolization remains unclear. This study evaluates the impact of AT resumption on hematoma resolution, recurrence, and reoperation rates, while assessing thromboembolic risks associated with interrupting AT therapy. METHODS: A retrospective review was conducted of patients undergoing MMA embolization for cSDH at a Level I trauma center from 2020 to 2023. Cases were stratified based on postprocedural AT resumption. Primary outcomes included >50% reduction in cSDH size and reoperation rate. Secondary outcomes included recurrence, functional outcomes measured by the modified Rankin Scale (mRS), and rate of thromboembolic complications in patients who withheld AT medications. Kaplan-Meier analysis compared recurrence-free survival between groups. RESULTS: A total of 120 patients (160 embolization cases) were included (mean age 72.1 ± 12.2 years; 48.5% women). AT therapy was resumed in 40 patients (53 cases, 33.1%) with a median restart time of 44 days. The non-AT group had similar initial hematoma thickness (13.7 ± 5.8 mm vs 12.0 ± 6.5 mm; P = .093). There were no differences in >50% hematoma reduction, recurrence, or reoperation rates between the groups ( P = .18, .50). Complete resolution was more frequent in the AT group (67.9% vs 43.0%). Partial resolution was more common in the non-AT group (67.5% vs 35.0%). Recurrence did not differ based on AT resumption within 30 days ( P = 1). Five patients (9.3%) experienced thromboembolic complications within 30 days before AT resumption, without an increase in mRS at last follow-up ( P = .33). The non-AT group had higher mRS scores overall ( P = .049). CONCLUSION: Resuming ATs within 30 days of MMA embolization did not affect recurrence or reoperation rates. Resumption of AT therapy within 2 weeks of MMA embolization may reduce thromboembolic complications.
Source: Neurosurgery Open
Institutions: Inova Fairfax Hospital, University of Virginia
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225638815