Grant: Project Grant

Blood accumulation on the outside of the brain is called chronic subdural hematoma (cSDH). This typically occurs because of a relatively trivial head trauma and is common in elderly patients. It is known that a high proportion of elderly patients also receive blood thinners for stroke prevention in the context of abnormal heart rhythms. Treatment of cSDH sometimes require surgery and use of blood thinner is usually withheld immediately after surgery due to fear of bleeding risk. This is important as there Is known possibility of bleeding after surgery. However, it has been unequivocally shown that withholding blood thinners carries the risk of stroke (which this drug was suppose to prevent in first place). Therefore, is hard to know when is best time to restart blood thinner and currently there is no consensus on when to restart blood thinner medications after surgery for cSDH. This is a small study designed to show the feasibility to perform a larger study to answer an important clinical question: in patients with blood thinner for stroke prevention prior to surgery for cSDH, does early restarting of blood thinner 4 weeks after surgery result in better overall physical and cognitive function (measure quantitatively in 3 months) compared to delayed restarting of blood thinner 3 months after surgery? This study will be performed at 6 Canadian hospitals. Patients that are suitable for study will be randomly divided into two groups of patients receiving: (1) early restart of blood thinner (4 weeks after surgery) or (2) late restart of blood thinner (3 months after surgery). In this study we will record the proportion of patients enter the study, complete the study as well as any evidence of bleeding in the brain or stroke. These results will be critical to inform on the design and planning of a larger-scale study that will answer one of the most common questions in the fields of stroke, geriatrics, trauma, and neurosurgery.