Glucagon-Like Peptide-1 Receptor Agonists for Patients with Conservatively Managed Nontraumatic Subdural Hematoma
Huanwen Chen, Matthew K. McIntyre, Jay Kakadiya, Pranjal Rai, Ahmed Y. Azzam, Muhammed Amir Essibayi, Hamza A. Salim, Daniel M. Mandel, Marc Buzzeli, Vivek S. Yedavalli, Adam A. Dmytriw, Ajay Malhotra, Dheeraj Gandhi, Marco Colasurdo, Dhairya A. LakhaniBACKGROUND AND OBJECTIVES:
Medical management options for nontraumatic subdural hematoma (SDH) remain limited, with only atorvastatin demonstrating benefit in a single phase 2 randomized clinical trial and mixed evidence for dexamethasone. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may benefit SDH outcomes. The objective of this study was to evaluate the association between GLP-1 RA use and rescue surgery rates and mortality in patients with medically managed nontraumatic SDH.
METHODS:
We conducted a retrospective cohort study using the TriNetX database from 2016 to 2025, including adults with SDH who were managed conservatively without surgical evacuation or middle meningeal artery embolization. Patients prescribed GLP-1 RAs were compared with nonusers. After propensity matching, rescue surgical evacuation, all-cause mortality at 1 year, and GLP-1 RA–associated adverse events were analyzed.
RESULTS:
A total of 134 901 patients with conservatively managed nontraumatic SDH were identified, of whom 1470 (1.1%) were GLP-1 RA users. After propensity score matching, 2922 patients remained, with 1461 in each group. At 1 year, GLP-1 RA users experienced significantly lower rates of rescue surgery (2.23% vs 3.51%;
CONCLUSION:
Among patients with medically managed nontraumatic SDH, GLP-1 RA use was associated with significantly lower rates of rescue surgery and all-cause mortality without significantly increased risk of common GLP-1 RA–related complications.