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Background <p>Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after&#xa0;MMAE and optimal resumption time remains unclear.</p> Methods <p>A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches of PubMed, Web of Science, Embase, and Scopus through February 28, 2025, identified English-language&#xa0;studies on cSDH treated by MMAE (with or without surgery) reporting AT resumption outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Primary outcomes included&#xa0;recurrence and radiographic measures. Data were pooled using a random-effects model in R software.</p> Results <p>Of 514 articles, 3 retrospective studies (233 patients) were included. Among these, 78 resumed AT therapy. Random-effects meta-analysis revealed no significant differences in recurrence&#xa0;(OR 1.64, 95% CI&#xa0;0.45–6.00, <i>P</i> = 0.45), final SDH thickness (MD: 0.27, 95% CI: -0.91, 1.44, <i>P</i> = 0.66), or reduction in SDH thickness (MD: -0.60, 95% CI: -2.15, 0.96, <i>P</i> = 0.45).&#xa0;Subgroup analyses (antiplatelet vs.&#xa0;anticoagulant, MMAE alone vs. MMAE + surgery, early resumption) also revealed no significant differences.&#xa0;Sensitivity analyses confirmed consistent results. All included studies were moderate-to-high&#xa0;quality.</p> Conclusion <p>Resuming AT therapy after cSDH management with MMAE alone or combined with surgery appears not to affect recurrence rates or hematoma resolution.&#xa0;Preliminary findings support the safety of both&#xa0;anticoagulant and antiplatelet agents&#xa0;as well as early resumption. However, larger prospective studies remain essential for confirming these observations and establishing best practices.</p>

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Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月3日

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  • Rahim Abo Kasem,
  • Joshua M. Venegas,
  • Ahmed Ibrahim,
  • Zachary S. Hubbard,
  • Muhammed Amir Essibayi,
  • Maeen Aldamouni,
  • Mouaz Al-Khalaf,
  • Laith Khokhar,
  • Alejandro M. Spiotta

摘要

Background

Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches of PubMed, Web of Science, Embase, and Scopus through February 28, 2025, identified English-language studies on cSDH treated by MMAE (with or without surgery) reporting AT resumption outcomes. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Primary outcomes included recurrence and radiographic measures. Data were pooled using a random-effects model in R software.

Results

Of 514 articles, 3 retrospective studies (233 patients) were included. Among these, 78 resumed AT therapy. Random-effects meta-analysis revealed no significant differences in recurrence (OR 1.64, 95% CI 0.45–6.00, P = 0.45), final SDH thickness (MD: 0.27, 95% CI: -0.91, 1.44, P = 0.66), or reduction in SDH thickness (MD: -0.60, 95% CI: -2.15, 0.96, P = 0.45). Subgroup analyses (antiplatelet vs. anticoagulant, MMAE alone vs. MMAE + surgery, early resumption) also revealed no significant differences. Sensitivity analyses confirmed consistent results. All included studies were moderate-to-high quality.

Conclusion

Resuming AT therapy after cSDH management with MMAE alone or combined with surgery appears not to affect recurrence rates or hematoma resolution. Preliminary findings support the safety of both anticoagulant and antiplatelet agents as well as early resumption. However, larger prospective studies remain essential for confirming these observations and establishing best practices.