PO057 | IS PLATELET FUNCTION TESTING CLINICALLY USEFUL IN PATIENTS WITH CHRONIC SUBDURAL HEMATOMA UNDERGOING NEUROSURGERY WHILE ON ANTIPLATELET THERAPY?

G. Ciarrocca Taranta¹, G. Pansini², S. Orlandini², O. Para³, M. Di Gioia⁴, A. Rogolino⁴, G. Barbieri¹, R. Marcucci^1|4, A. Della Puppa² | ¹Dep of Experimental and Clinical Medicine, University of Florence, Italy; ²Neurosurgical Dep, Careggi University Hospital, Firenze, Italy; ³Internal Medicine 1 Careggi University Hospital, Firenze, Italy; ⁴Atherothrombotic Diseases, Careggi University Hospital, Firenze, Italy

Background and aims. Patients undergoing neurosurgery are increasingly treated with antiplatelet therapy, which increases bleeding risk and complicates the management of chronic subdural hematoma (CSDH), a condition for which clear guidelines are lacking. Platelet function testing may help optimize the timing of neurosurgical intervention by balancing hemorrhagic and thrombotic risks, given the variability in individual responses to antiplatelet drugs. This study aims to evaluate the safety and clinical utility of platelet reactivity testing in patients undergoing neurosurgical evacuation of CSDH.
Methods. We conducted a case–control study including patients undergoing surgical evacuation of CSDH between 2022 and 2025. Cases were patients on antiplatelet therapy with an urgent surgical indication who showed early normalization of platelet function on reactivity testing (i.e., normalization before the recommended drug withdrawal period). Controls were patients not receiving antiplatelet therapy. Outcomes included early complications (<7 days), and 30-day recurrences.
Results. A total of 333 patients were included: 176 cases and 157 controls. Patients on antiplatelet therapy were older (81.1±7.4 vs 77.0±11.4 years; p<0.001) and had a higher prevalence of hypertension (63.6% vs 48.1%; p=0.004) and diabetes (26.7% vs 12.7%; p=0.02), while other clinical and hematological characteristics were comparable. Among cases, aspirin monotherapy was the most common regimen (70.5%), followed by clopidogrel (23.9%) and combination therapy (~6%). Preoperative platelet inhibition was observed in 34.6% of clopidogrel-treated patients (PRU <208) and 97.8% of aspirin-treated patients (ARU <550). Early normalization of platelet function was achieved in most patients (98% for ARU; 98% for PRU). No significant differences were observed between groups (cases and controls) in early postoperative complications (<7 days) or 30-day recurrence. The incidence of surgical complications at 7 days was similar between groups (p=0.818), as were recurrence rates at 30 days (p=0.698).
Conclusions. Platelet function testing appears to be a safe and potentially useful tool to guide the timing of neurosurgical intervention in CSDH patients receiving antiplatelet therapy. Its use may allow earlier surgery without increasing hemorrhagic or ischemic complications, potentially reducing hospitalization time and improving clinical management.