In an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

在老龄化的西方社会，慢性硬膜下血肿 (cSDH) 的发病率不断增加。在这项研究中，我们回顾了我们对 cSDH 患者的临床管理，并确定了因残留或复发性血肿而需要再次手术的预测因素，重点是抗血栓药物的使用。回顾性分析了2006年至2016年在我科接受cSDH手术清除的623例患者。通过单变量和多变量分析，研究了临床和放射学特征以及实验室参数作为再手术的可能预测因素。此外，还比较了服用抗凝剂、服用抗血小板药物和未服用抗血栓药物的患者的临床结局指标。在单变量分析中，使用抗凝剂和抗血小板剂的患者出现合并症的频率显着增加，年龄显着增加，围手术期并发症的风险显着增加。然而，他们的临床结果与未使用抗血栓药物的患者相当。在多变量分析中，只有合并症的存在而不是抗血栓形成药物是需要再次手术的独立预测因素。使用抗血栓药物的患者在 cSDH 清除后残留血肿或需要再次手术的再出血的风险似乎未必显着增加。更准确地说，易感合并症的存在可能是再次手术的关键独立风险因素。重要的是，cSDH 手术清除后的临床结果在使用抗凝剂的患者之间具有可比性，