To determine the cardiovascular risks of withholding anticoagulants/antiplatelet medications in high-risk patients (e.g. patients with cardiac stents, prosthetic heart valves, atrial fibrillation, etc.) after craniotomy or in the setting of subdural hematoma managed non-operatively for up to 8-weeks.

We retrospectively reviewed 456 cases of traumatic subdural hematomas (tSDH) at our institution from 2014-2018. We recorded whether they were taking AP and/or AC at the time of the trauma, the relevant comorbidities necessitating AP/AC (myocardial infarction (MI), coronary stent, coronary artery bypass graft (CAGB), prosthetic heart valve, stroke, DVT/PE, and atrial fibrillation), and when these medications were restarted after discharge. We report rates of unplanned hematoma evacuation and thromboembolic events (DVT/PE, MI, and stroke) within 90-days of discharge.

268 patients were on AP and/or AC at the time of tSDH. The rate of unplanned hematoma evacuation within 90-days of hospital discharge in patients not receiving AP/AC was 6.4% and the rate of thromboembolic events during the same time period was 1.0%. Patients with comorbidities necessitating AP/AC had similar rates of unplanned hematoma evacuation (3.6%?8.0%) but had higher rates of thromboembolic events (4.3%?25.0%) compared to those not requiring AP/AC, particularly patients with history of CABG, DVT/PE, and atrial fibrillation. Relevant AP/AC medications were typically restarted 2-4 weeks after discharge.

 Patients with medical comorbidities requiring reinitiation of AP/AC after tSDH were at elevated risk of thromboembolism but had similar rates of unplanned hematoma evacuation as patients not receiving AP/AC. Therefore, patients requiring reinitiation of AP/AC after tSDH should be followed closely until these medications are restarted.