{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T02:10:55Z","timestamp":1778292655584,"version":"3.51.4"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54 GM104942"],"award-info":[{"award-number":["U54 GM104942"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The optimal timing for reinitiating antiplatelet therapy after treatment of chronic subdural hematoma (cSDH) remains uncertain, especially when middle meningeal artery embolization (MMAE) is used as an adjunct to surgery. This study evaluated the safety and outcomes of early antiplatelet reinitiation in patients undergoing combined surgical evacuation and MMAE, and compared outcomes in antiplatelet-treated patients receiving surgery with versus without MMAE. Adult cSDH patients from the TriNetX database (May 2020\u2013May 2025) were identified using ICD-10 and RXNORM codes. Two propensity score\u2013matched analyses were performed: (1) patients receiving surgery with adjunct MMAE, stratified by antiplatelet initiation within 30 days; and (2) antiplatelet-treated patients undergoing surgery with adjunct MMAE versus surgery alone. Outcomes included rescue surgery and 6-month mortality. After matching, early antiplatelet use in surgery\u2009+\u2009MMAE patients (n\u2009=\u2009163 per group) was not associated with higher rescue surgery rates (OR 0.68, 95% CI 0.32\u20131.48) or mortality (OR 1.52, 95% CI 0.73\u20133.20). Among antiplatelet-treated patients, surgery\u2009+\u2009MMAE (n\u2009=\u2009176) had similar rescue surgery rates to surgery alone (n\u2009=\u2009176) but significantly lower mortality (10.8% vs. 21.0%; OR 0.46, 95% CI 0.25\u20130.83, p\u2009=\u20090.009). Early antiplatelet reinitiation appeared safe after cSDH evacuation with adjunct MMAE. The associated lower 6-month mortality with adjunct MMAE in antiplatelet-treated patients is observational and hypothesis-generating, and warrants prospective confirmation.<\/jats:p>","DOI":"10.1007\/s10143-026-04318-6","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T01:37:58Z","timestamp":1778290678000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reinitiating antiplatelet therapy in chronic subdural hematoma: Does adjunctive middle meningeal artery embolization improve outcomes?"],"prefix":"10.1007","volume":"49","author":[{"given":"Muhammed Amir","family":"Essibayi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Kakadiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamza Adel","family":"Salim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huanwen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Y.","family":"Azzam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam A.","family":"Dmytriw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek S","family":"Yedavalli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad A.","family":"Kassar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Colasurdo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dheeraj","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Khatri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Haranhalli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Altschul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhairya A.","family":"Lakhani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"4318_CR1","doi-asserted-by":"publisher","first-page":"e671","DOI":"10.1016\/j.wneu.2019.01.151","volume":"125","author":"PM Foreman","year":"2019","unstructured":"Foreman PM, Mooney J, Ilyas A, Agee B, Vivekanandan S, Fong RP, Okor MO, Riley KO, Griessenauer CJ (2019) Antiplatelet Medication and Operative Subdural Hematomas: A Retrospective Cohort Study Evaluating Reoperation Rates. 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This is because, as a federated network, any data displayed on the TriNetX Platform (whether in aggregate form or as patient-level data in a generated dataset) contains only de-identified data, adhering to the de-identification standard defined in Section \u00a7\u00a0164.514(a) of the HIPAA Privacy Rule.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"As the TriNetX lacks patient identifiers, this study was exempt from institutional review board approval.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Internal Review Board (IRB) declaration"}},{"value":"As the TriNetX lacks patient identifiers, this study was exempt from informed consent requirements.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate declaration"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}},{"value":"Dhairya A Lakhani, MD.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"David Altschul reports securities holdings in Von Vascular, Inc, and compensation from Johnson and Johnson International, Stryker Corporation, Medtronic USA, Inc, and MicroVention, Inc, for consultant services. Vivek Yedavalli is consultant for iSchemaView, RapidAI. Dheeraj Gandhi receives research grants from the Focused Ultrasound Foundation, NIH, University of Maryland Medical Center, and Microvention, and is a consultant for Navigantis. Dhairya Lakhani is consultant for iSchemaView, RapidAI and Scientific advisory board member for Upstream Vision.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"398"}}