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Introduction The optimal timing for resumption of antiplatelet therapy following middle meningeal artery (MMA) embolization for subdural hematoma (SDH) remains unclear. Early resumption may reduce thrombotic risk but raises concern for hematoma progression. We evaluated whether early antiplatelet restart after MMA embolization is associated with worse 90-day clinical outcomes.Materials and Methods We performed a retrospective cohort study of patients who underwent MMA embolization with polyvinyl alcohol particles for treatment of SDH at a single institution. Patients deemed nonsurgical candidates were excluded. Among patients receiving antiplatelet therapy prior to embolization, early resumption was defined as restart within 10 days following the procedure. Ninety-day outcomes were categorized as favorable (no new neurological symptoms) or unfavorable (worsening neurological symptoms with radiographic progression, progression requiring surgical evacuation, or mortality). Multinomial logistic regression was used to assess associations between antiplatelet restart timing and outcomes, adjusting for age, sex, and total SDH diameter (sum of bilateral maximal diameters).Results A total of 460 patients were included, of whom 106 resumed antiplatelet therapy within 90 days after MMA embolization. After multivariable adjustment, early antiplatelet restart (≤10 days) was not independently associated with unfavorable 90-day outcome compared with no restart (relative risk ratio [RRR] 1.46, 95% confidence interval [CI] 0.65-3.31). Increasing total SDH diameter was independently associated with worse outcome (RRR 1.04 per mm, 95% CI 1.01-1.07), as was male sex (RRR 1.91, 95% CI 1.10-3.29). Age was not independently associated with outcome.Conclusion Early resumption of antiplatelet therapy following MMA embolization was not associated with worse 90-day clinical outcomes after adjustment for hematoma burden and patient factors. These findings suggest that early antiplatelet restart may be considered in appropriately selected patients without independently increasing short-term adverse outcomes.Disclosures S. Ransom: None. N. Kendall: None. C. Rinalli: None. R. Zhou: None.