Can antithrombotic therapy be safely resumed after middle meningeal artery embolization with or without surgery for chronic subdural hematoma? a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Middle meningeal artery embolization (MMAE), whether alone or with surgery, reduces chronic subdural hematoma (cSDH) recurrence. However, the impact of resuming antithrombotic (AT) therapy after MMAE and optimal resumption time remains unclear. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches of PubMed, Web of Science, Embase, and Scopus through February 28, 2025, identified English-language studies on cSDH treated by MMAE (with or without surgery) reporting AT resumption outcomes. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Primary outcomes included recurrence and radiographic measures. Data were pooled using a random-effects model in R software. RESULTS: Of 514 articles, 3 retrospective studies (233 patients) were included. Among these, 78 resumed AT therapy. Random-effects meta-analysis revealed no significant differences in recurrence (OR 1.64, 95% CI 0.45-6.00, P = 0.45), final SDH thickness (MD: 0.27, 95% CI: -0.91, 1.44, P = 0.66), or reduction in SDH thickness (MD: -0.60, 95% CI: -2.15, 0.96, P = 0.45). Subgroup analyses (antiplatelet vs. anticoagulant, MMAE alone vs. MMAE + surgery, early resumption) also revealed no significant differences. Sensitivity analyses confirmed consistent results. All included studies were moderate-to-high quality. CONCLUSION: Resuming AT therapy after cSDH management with MMAE alone or combined with surgery appears not to affect recurrence rates or hematoma resolution. Preliminary findings support the safety of both anticoagulant and antiplatelet agents as well as early resumption. However, larger prospective studies remain essential for confirming these observations and establishing best practices.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.035 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.041 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".