ABSTRACT Purpose Clinicians are often concerned that early resumption of antiplatelet therapy may increase the risk of recurrence after burr‐hole surgery for chronic subdural hematoma (CSDH), yet studies on this issue remain limited. We evaluated whether early resumption of antiplatelet therapy increases CSDH recurrence using a target trial emulation framework. Methods We identified patients who had received antiplatelet therapy preoperatively and undergone initial burr‐hole surgery for CSDH from two hospital‐based administrative databases (2016–2024). To estimate CSDH recurrence risk with early resumption, we compared two treatment strategies: strategy 1, resumption of antiplatelet therapy within 4 days after the initial burr‐hole surgery; and strategy 2, no resumption within 30 days after the initial burr‐hole surgery. We employed the clone–censor–weight method to address immortal time and time‐varying confounders. Using a stabilized weighted pooled logistic regression model, we then calculated the 30‐, 60‐, and 90‐day risk of CSDH recurrence. Results Among 1552 eligible patients, 217 (14.0%) experienced CSDH recurrence within 90 days. Risk of CSDH recurrence at 30, 60, and 90 days was 8.1%, 13.7%, and 14.2% for strategy 1 versus 7.2%, 12.5%, and 13.9% for strategy 2. The respective risk ratios were 1.13 (95% CI, 0.76–1.56), 1.10 (0.75–1.51), and 1.02 (0.71–1.40), and the risk differences were 0.9% (−2.2 to 3.4), 1.2% (−3.7 to 5.2), and 0.3% (−4.8 to 4.6). Conclusions This study suggests that early resumption of antiplatelet therapy may not increase CSDH recurrence risk. These findings may inform clinical decision‐making regarding postoperative antiplatelet management.
Anno et al. (Mon,) studied this question.