The Management of Patients with Chronic Subdural Hematoma Treated with Low-Dose Acetylsalicylic Acid: An International Survey of Practice

BACKGROUND: The aim of this international survey was to investigate the current management of patients undergoing surgery for chronic subdural hematoma (cSDH) treated with low-dose acetylsalicylic acid (ASA). METHODS: We administered a survey via e-mail to neurosurgeons with questions relating to the surgical treatment of cSDH, emphasizing their practices with patients treated with low-dose ASA. RESULTS: We received 157 responses, with a response rate of 22.4%. Almost 80% of the responders discontinue ASA treatment at least 5 days before surgery and 80.7% resume treatment after 5 days or more, and 27.6% discontinue treatment for at least 30 days. The main factor influencing ASA resumption time is the indication for ASA (54.5%), and postoperative imaging is concluded in 71.7%, Postoperative thrombosis prophylaxis is administered by 60% of the responders, and 50% apply it 24 hours after surgery. Almost 95% of the responders believe that better evidence is needed for the management of patients with cSDH treated with ASA. Guidelines for these patients exist in only 24.3% of the institutes. CONCLUSIONS: Most neurosurgeons discontinue ASA treatment for at least 7 days in the perioperative period of surgical evacuation of cSDH, even though recent studies show that early ASA resumption might be safe. Thrombosis prophylaxis is administered by only 60%, even though patients with cSDH are at high risk of developing thromboembolic complications. Better evidence and guidelines are warranted because the incidence of patients with cSDH under the treatment of ASA is increasing.