Flow, Liver, Flow: A Retrospective Analysis of the Interplay of Liver Disease and Coagulopathy in Chronic Subdural Hematoma

John Paul George Kolcun, Joanna Elizabeth Gernsback, Angela Mae Richardson, Jonathan Jagid

Research output: Contribution to journalArticlepeer-review


Background Chronic subdural hematoma (cSDH) is a common neurosurgical ailment, particularly in elderly patients. A recent study uncovered an association between liver disease and recurrence in patients with cSDH. Here, we explored that relationship to identify recurrence predictors in at-risk patients. Objective We hypothesized that the association between liver disease and recurrence was attributable to coagulopathy secondary to liver disease. Methods We retrospectively reviewed all patients with cSDH treated with burr-hole drainage by 2 surgeons between 2007 and 2015. Comorbidities and laboratory findings for each patient were examined by Pearson χ2 analysis or Mann-Whitney U tests. Results We identified 261 cSDH in 215 patients. Patients were a mean age of 65.6 years, and 72% were male. Sixteen patients with cSDH required repeat surgery (6.1%). There were 123 coagulopathic patients (47.1%), and 14 with liver disease (5.4%), all of whom were coagulopathic (P < 0.001). Coagulopathic patients with liver disease were more likely to experience recurrence than patients with coagulopathy alone (relative risk = 4.09, P = 0.019). Patients with liver disease had significantly elevated prothrombin time (P = 0.013) and reduced platelet counts (P < 0.001). Platelets also were reduced in coagulopathic patients with liver disease, as compared with those with coagulopathy alone (P = 0.002). Thrombocytopenia remained significant in a multivariate analysis (P < 0.001). Conclusions Liver disease is significantly associated with the recurrence of cSDH. Although coagulopathy alone does not predict recurrence, patients with coagulopathy and liver disease are at greater risk for recurrence than those with coagulopathy alone. Liver disease effects are reflected in certain hematologic laboratory values.

Original languageEnglish (US)
Pages (from-to)246-252
Number of pages7
JournalWorld Neurosurgery
StatePublished - Jun 1 2017


  • Burr hole drainage
  • Chronic subdural hematoma
  • Cirrhosis
  • Coagulopathy
  • Liver disease
  • Recurrence

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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