The Role of Angiotensin-Converting Enzyme Inhibitors in Patients with Chronic Subdural Hematoma: A Scandinavian Population-Based Multicenter Study

Jiri Bartek Jr; Kristin Sjåvik; Samuel Schaible; Sasha Gulati; Ole Solheim; Petter Förander; Asgeir Store Jakola

doi:10.1016/j.wneu.2018.02.094

The Role of Angiotensin-Converting Enzyme Inhibitors in Patients with Chronic Subdural Hematoma: A Scandinavian Population-Based Multicenter Study

World Neurosurg. 2018 May:113:e555-e560. doi: 10.1016/j.wneu.2018.02.094. Epub 2018 Feb 23.

Authors

Jiri Bartek Jr¹, Kristin Sjåvik², Samuel Schaible³, Sasha Gulati⁴, Ole Solheim⁴, Petter Förander⁵, Asgeir Store Jakola⁶

Affiliations

¹ Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. Electronic address: jiri.bartek@karolinska.se.
² Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
³ Faculty of Health Sciences, University of Heidelberg, Heidelberg, Germany.
⁴ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
⁵ Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Sweden.

PMID: 29477701
DOI: 10.1016/j.wneu.2018.02.094

Abstract

Objective: To investigate the role of angiotensin converting enzyme (ACE) inhibitors in the recurrence of chronic subdural hematoma (cSDH) after burr hole surgery.

Methods: A retrospective review was conducted of a Scandinavian multicenter, population-based cohort of 1252 adults with cSDH who underwent with burr hole surgery between January 1, 2005, and December 31, 2010. The risk of cSDH recurrence was assessed in users of ACE inhibitors, users of angiotensin II receptor blockers (ARBs), and those without ACE inhibitor treatment (no ACE inhibitor group) using univariable and multivariable regression analyses.

Results: The cohort included 98 (7.8%) ACE inhibitor users and 63 (5%) ARB-only users. The recurrence rate was 16.3% (n = 16) in the ACE inhibitor group, compared with 13.3% (n = 153) in the no ACE inhibitor group (P = 0.39) and 14.3% (n = 9) in the ARB group (P = 0.73). When comparing groups, age (P = 0.01), Charlson Comorbidity Index (P = 0.01), use of platelet inhibitors (P = 0.001) and use of anticoagulants (P = 0.01) differed between the ACE inhibitor and no ACE inhibitor groups. Only age differed significantly between the ACE inhibitor and ARB groups (P = 0.03). In the analyses adjusted for differences in baseline characteristics, ACE inhibitor treatment did not influence the risk of recurrence (odds ratio, 1.2; 95% confidence interval, 0.7-2.2; P = 0.46).

Conclusion: In this population-based study, the use of ACE inhibitors was not associated with the risk of recurrence following burr hole surgery for cSDH.

Keywords: Angiotensin II receptor blocker; Angiotensin-converting enzyme inhibitor; Chronic subdural hematoma; Neurosurgery; Recurrence.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Cohort Studies
Female
Hematoma, Subdural, Chronic / diagnosis
Hematoma, Subdural, Chronic / drug therapy*
Hematoma, Subdural, Chronic / epidemiology*
Humans
Male
Middle Aged
Population Surveillance* / methods
Recurrence
Retrospective Studies
Scandinavian and Nordic Countries / epidemiology

Substances

Angiotensin-Converting Enzyme Inhibitors