Antithrombotic Drug Use Associated with Higher Risk of Subdural Hematoma
April 1, 2017 less than 1 minute read
Antithrombotic medications increase the risk of subdural hematoma, with vitamin K antagonists (VKAs) such as warfarin producing the highest risk. Researchers from Denmark performed a case-control study of more than 10,000 patients presenting with first-ever subdural hematoma from 2000-2015 matched to more than 400,000 individuals from the general population. The drugs compared included low-dose aspirin, clopidogrel, VKAs, direct oral anticoagulants (dabigatran, rivaroxaban, or apixaban), or combinations of drugs. Almost 50% of patients with subdural hematoma were taking one of these medications. The odds ratios for subdural hematoma were: low-dose aspirin, 1.24; clopidogrel, 1.87; a direct oral anticoagulant, 1.73; and VKA, 3.69. The risk was highest when patients were on an antiplatelet drug along with a VKA. The odds ratio for VKA plus low-dose aspirin was 4.00 and VKA plus clopidogrel, 7.93. The authors noted that antithrombotic use increased during the 15-year study period. They concluded that antithrombotic drug use was associated with higher risk of subdural hematoma, and the highest odds of subdural hematoma was associated with combined use of a VKA and an antiplatelet drug (JAMA 2017;317:836-846). This study suggests that the newer direct oral anticoagulants may be safer in this regard than warfarin therapy.
This study suggests that the newer direct oral anticoagulants may be safer in this regard than warfarin therapy.
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