Aspirin Continuation or Discontinuation in Conservative Treatment for Chronic Subdural Hematoma
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Aspirin Continuation, Aspirin Discontinuation.
- Who it may be relevant to
- Registry conditions: Chronic Subdural Hematoma. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- China
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Safety and Efficacy of Aspirin Continuation or Discontinuation in Conservative Treatment for Chronic Subdural Hematoma: A Randomized Clinical Trial
Overview
This clinical study aims to learn about the efficacy and safety of aspirin continuation or discontinuation in conservative treatment for chronic subdural hematoma. All participants received standard conservative treatment for chronic subdural hematoma, with a randomized intervention to either continue or discontinue aspirin administration. By participating in this study, participants can receive additional scientific guidance on aspirin medication management beyond routine conservative treatment, thereby optimizing individualized therapy.
Detailed description
Chronic subdural hematoma is a common condition in neurosurgery, predominantly affecting the elderly. Its incidence increases with age, often developing gradually following minor head trauma. Clinical manifestations vary widely, with severe cases potentially leading to coma or even death, imposing a significant burden on patients and their families.
Current treatment approaches for chronic subdural hematoma include surgical intervention and conservative management. Conservative treatment is suitable for some patients with milder conditions or high surgical risk, primarily involving bed rest and medication. However, its efficacy varies among individuals, and close monitoring for multiple potential complications is essential throughout the treatment process.
Aspirin, a commonly used antiplatelet agent, is widely applied in the prevention and treatment of cardiovascular and cerebrovascular diseases. Its use in chronic subdural hematoma patients presents complexities: some patients had been taking aspirin long-term prior to onset. Whether to continue aspirin during conservative management remains controversial, necessitating further research to clarify its safety and efficacy. Continuing the medication may increase the risk of hematoma enlargement, while discontinuation may trigger thromboembolic events.
For cSDH patients on long-term aspirin therapy who opt for conservative management, there is currently no guideline or consensus on "continue vs. discontinue." Clinical decisions are often made by multidisciplinary teams (MDTs) based on individualized risk assessment of bleeding versus thrombosis (with a higher rate of discontinuation strategies). A randomized controlled trial in surgical patients (JAMA Neurology, 2025) showed that discontinuing aspirin after surgery did not reduce 6-month recurrence, and discontinuation-related complications showed no significant difference, suggesting that a "one-size-fits-all" discontinuation approach is unreasonable. However, this evidence cannot be extrapolated to the conservative treatment population, making the conduct of this RCT practically necessary.
Interventions
- Drug Aspirin Continuation
All participants received standard conservative treatment for chronic subdural hematoma, with a randomized intervention to continue aspirin administration. This group of participants received oral administration of aspirin at a dose of 100 mg per day. - Drug Aspirin Discontinuation
All participants received standard conservative treatment for chronic subdural hematoma, with a randomized intervention to discontinue aspirin administration. This group of participants did not use aspirin during the treatment period.
Primary outcome measures
- recurrence or progression of the subdural hematoma [Time frame: 6 months]
Secondary outcome measures (11)
- modified Rankin Score (mRS) [Time frame: at 6 months]
- Surgical conversion rate [Time frame: at 6 months]
- mortality [Time frame: at 6 months]
- Peripheral vascular events [Time frame: 6 months]
- Acute cardiovascular and cerebrovascular events [Time frame: 6 months]
- new-onset contralateral chronic subdural hematoma [Time frame: 6 months]
- Change in hematoma volume [Time frame: 6 months]
- EQ-5D-5L Questionnaire [Time frame: 6 months]
- Montreal Cognitive Assessment Scale [Time frame: 6 months]
- Red Blood Cell Lifespan [Time frame: 6 months]
- Other adverse events [Time frame: 6 months]
Eligibility criteria
Inclusion criteria
- Age ≥18 years, male or female;
- Confirmed diagnosis of chronic subdural hematoma (cSDH) by cranial CT and/or MRI;
- Intended for conservative management (i.e., no surgical evacuation indication at enrollment);
- Regular aspirin use at enrollment;
- Informed consent signed by the patient or legal representative.
Exclusion criteria
- Patients requiring emergency surgery to remove hematoma at enrollment;
- Concurrent use of other anticoagulants or antiplatelet agents that cannot be discontinued according to the study protocol;
- cSDH secondary to other diseases or conditions (e.g., excessive drainage from ventriculoperitoneal shunts, intracranial tumors);
- Active bleeding events or major cardiac events (e.g., acute myocardial infarction, unstable angina, or revascularization surgery) within 30 days prior to enrollment;
- Known bleeding disorders (e.g., hemophilia, severe thrombocytopenia);
- Individuals unable to provide informed consent or for whom completion of follow-up is anticipated to be difficult.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
China · 2 centers
- Xuanwu Hospital Capital Medical University — Beijing
- Tianjin Medical University General Hospital — Tianjin
Identifiers
NCT: NCT07240454 · Aspirin CSDH