To analyze the trepanation and drainage on the aged patients with chronic subdural hematoma (CSDH) taking oral antiplatelet drugs.

59 aged patients with CSDH treated by drilling and drainage from July 2014 to December 2018 in Zhejiang Hospital were selected. 29 patients taking oral antiplatelet drugs were selected as observation group and 30 patients not taking oral antiplatelet drugs were selected as control group. Patients in the observation group were recommended to stop antiplatelet drugs for 7 days before surgery. If emergency surgery was required, 10 units of platelets should be injected before the operation. All patients were given atorvastatin 20 mg (1 time/d) orally before and after surgery, trepanation and drainage was performed routinely. The postoperative clinical symptoms and improvement of neurological defect degree, changes of intracranial pneumatosis and subdural effusion, and recurrence of hematoma in the two groups were observed and compared. T test was used for comparison of measurement data between groups, while chi-square test was used for comparison of enumeration data.

There were no statistically significant differences in the distribution of post operation Bender grades, the incidence of poor brain recruitment of different degrees or a small amount of intracranial pneumatosis between the two groups (χ²=1.344、2.076, P > 0.05). Postoperative recurrence occurred in 6 patients in the observation group, recurrence occurred in 1 case in the control group, the difference was statistically significant (χ²=4.248, P < 0.05). In addition, the recurrence rate of aged CSDH patients who stopped taking oral antiplatelet drugs for one week before operation [6.25%(1/16)] was lower than patients who stopped taking oral antiplatelet drugs for less than one week [29.6%(5/13)] (χ²=4.535, P < 0.05).

Drilling and drainage still is the preferred treatment on the aged CSDH patients with taking oral antiplatelet drugs. Although oral antiplatelet drugs can increase the risk of bleeding in perioperative period and recurrence, but reasonably stopping antiplatelet drugs in perioperative period and platelet transfusion can reduce the risk.