Impact of Antivascular Endothelial Growth Factor Therapy in Chronic Subdural Hematoma Patients: A Propensity-Matched Multi-Institutional Cohort Study.

BACKGROUND

To evaluate possible associations between anti-VEGF (vascular endothelial growth factor) therapy and cSDH (chronic subdural hematoma) outcomes.

METHODS

We conducted a cohort study using the TriNetX Research Network, comparing patients with cSDH taking anti-VEGF agents to controls through propensity score matching. Outcomes measured were assessed at 6 months and 1 year follow-up and included cSDH rebleeding, endovascular or surgical cSDH treatment, mortality, headaches, stroke, arterial hypertension, proteinuria, and major bleeding (noncranial).

RESULTS

After propensity matching, 737 patients were included in both anti-VEGF and control cohorts at 6 months, and 722 patients in each cohort at 1 year. Baseline characteristics were well balanced. At 6-months, the anti-VEGF group had significantly lower odds of rebleeding (odds ratio [OR], 0.204 [95% CI, 0.159-0.26]; P<0.001), craniotomy (OR, 0.340 [95% CI, 0.155-0.680]; P=0.002), and mortality (OR, 0.778 [95% CI, 0.615-0.990]; P=0.037). At 1-year, reduced odds persisted for rebleeding (OR, 0.158 [95% CI, 0.122-0.200]; P<0.001), craniotomy (OR, 0.250 [95% CI, 0.116-0.490]; P<0.001), embolization (OR, 0.380 [95% CI, 0.172-0.770]; P=0.007), and mortality (OR, 0.677 [95% CI, 0.520-0.880]; P=0.003). Arterial hypertension was higher in the anti-VEGF group at 6 months (OR, 1.240 [95% CI, 1.000-1.530]; P=0.048), but not 1 year (OR, 1.110 [95% CI, 0.904-1.350]; P=0.330). No significant differences were observed in headache, stroke, proteinuria, or major bleeding at either time point.

CONCLUSIONS

Anti-VEGF therapy is associated with significantly reduced rebleeding, reintervention rates, and mortality in patients with cSDH at both 6 months and 1 year. A transient increased incidence of arterial hypertension was noted at 6 months, but other major adverse events were not significantly different. Further randomized, prospective studies are warranted to confirm these results and optimize treatment strategies.