Impact of Thrombocytopenia on Preoperative Hematoma Expansion for Acute Traumatic Subdural Hematoma

-BACKGROUND: Acute subdural hematoma is a neuro-surgical emergency. Thrombocytopenia poses a manage-ment challenge for these patients. We aimed to determine the impact of thrombocytopenia on preoperative hemor-rhage expansion and postoperative outcomes. -METHODS: This retrospective study evaluated patients presenting at our institution with acute subdural hematoma between 2009 and 2019. Patients who underwent surgery, had thrombocytopenia (platelets <150,000/mL), and had multiple preoperative computed tomography scans were included. Case control 1:1 matching was performed to generate a matched cohort with no thrombocytopenia. Univariate analyses were conducted to determine changes in subdural thickness and midline shift, postoperative Glasgow Coma Scale score, mortality, length of stay, and readmission rates. -RESULTS: We identified 19 patients with both throm-bocytopenia and multiple preoperative computed tomog-raphy scans. Median platelet count was 112,000/mL (Q1 69,000, Q3 127,000). Comparing the thrombocytopenia cohort with the control group, there was a statistically significant difference in change in subdural thickness (median 5 mm [Q1 2, Q3 7.4] vs. 0 mm [Q1 0, Q3 1.5]; P = 0.001) and change in midline shift (median 3 mm [Q1 0, Q3 9.5] vs. median 0.5 mm [Q1 0, Q3 1.5]; P = 0.018). The thrombocytopenia cohort had higher in-hospital mortality (10 [52.6%] vs. 2 [10.5%]; P = 0.003). No significant differences were found in postoperative Glasgow Coma Scale score, length of stay, number of readmissions, and n umber of reoperations. -CONCLUSIONS: Thrombocytopenia is significantly associated with expansion of hematoma preoperatively in patients with acute subdural hematoma. While the benefit of early platelet correction cannot be determined from this study, patients who present with thrombocytopenia will benefit from close monitoring, a low threshold to obtain repeat imaging, and anticipating early surgical evacuation after platelet optimization.

Automated summary

This study aimed to determine the impact of thrombocytopenia on preoperative hemorrhage expansion and postoperative outcomes in patients with acute subdural hematoma. The results showed that thrombocytopenia was significantly associated with expansion of hematoma preoperatively and higher in-hospital mortality in these patients.