Perioperative Management of Anticoagulation

Guha, Daipayan; Macdonald, R. Loch

doi:10.1016/j.nec.2016.11.011

Cited by 14 publications

(4 citation statements)

References 61 publications

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“…24,27 Early ASA resumption or even continued perioperative intake was shown to be safe for burr-hole drainage in chronic subdural hematoma (cSDH) as well as shunt placement. 9,10,14,15,17 To our knowledge, there are no randomized controlled trials (RCTs) analyzing bleeding risk with continued perioperative AP/AC treatment in neurosurgery. A protocol for an ongoing RCT of continued ASA treatment for patients undergoing surgical evacuation of cSDH has been published and the study is currently ongoing.…”

Section: Management Of Ap/ac Treatment In Neurosurgical Patientsmentioning

confidence: 99%

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Greuter

Ullmann

Mariani

et al. 2019

Neurosurgical Focus

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OBJECTIVETraumatic brain injury (TBI) is common among the elderly, often treated with antiplatelet (AP) or anticoagulation (AC) therapy, creating new challenges in neurosurgery. In contrast to elective craniotomy, in which AP/AC therapy is mostly discontinued, in TBI usually no delay in treatment can be afforded. The aim of this study was to analyze the effect of AP/AC therapy on postoperative bleeding after craniotomy/craniectomy in TBI.METHODSPostoperative bleeding rates in patients treated with AP/AC therapy (blood thinner group) and in those without AP/AC therapy (control group) were retrospectively compared. Furthermore, univariate and multivariate analyses were conducted to identify risk factors for postoperative bleeding. Lastly, a proportional Cox regression analysis comparing postoperative bleeding events within 14 days in both groups was performed.RESULTSOf 143 consecutive patients undergoing craniotomy/craniectomy for TBI between 2012 and 2017, 47 (32.9%) were under AP/AC treatment. No significant difference for bleeding events was observed in univariate (40.4% blood thinner group vs 36.5% control group; p = 0.71) or Cox proportional regression analysis (log rank χ2 = 0.29, p = 0.59). Patients with postoperative bleeding showed a significantly higher mortality rate (p = 0.035). In the univariate analysis, hemispheric lesion, acute subdural hematoma, hematological disease, greater extent of midline shift, and pupillary difference were significantly associated with a higher risk of postoperative bleeding. However, in the multivariate regression analysis none of these factors showed a significant association with postoperative bleeding.CONCLUSIONSPatients treated with AP/AC therapy undergoing craniotomy/craniectomy due to TBI do not appear to have increased rates of postoperative bleeding. Once postoperative bleeding occurs, mortality rates rise significantly.

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Section: Management Of Ap/ac Treatment In Neurosurgical Patientsmentioning

confidence: 99%

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Greuter

Ullmann

Mariani

et al. 2019

Neurosurgical Focus

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“…The American College of Chest Physicians recommends managing perioperative antithrombotics based on the risk for thromboembolism and bleeding in which the decision to hold, modify, or continue the AP/AC is based on the patient’s assessment. 5 For routine operations, most neurosurgeons recommend that blood thinners are held for a few days prior to the scheduled surgery date. 6 However, following TBIs, early discontinuation of AP/AC is no longer an option and as a result, procedures are often performed under the consequences of the AP/AC agent taken prior to admission.…”

Section: Introductionmentioning

confidence: 99%

Effect of Antiplatelet and Anticoagulant Agents on Outcomes Following Emergent Surgery for Traumatic Brain Injuries

Bazzi

Sharp

Hecht

2023

The American Surgeon™

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Purpose Traumatic brain injury (TBI) is the largest cause of death from injury in the United States. This study utilized the Michigan Trauma Quality Improvement Program (MTQIP) database to determine the effect that antiplatelets and anticoagulants (AP/AC) have on outcomes following emergent surgery for TBI patients. Basic Procedures Patients were included with age ≥18 years, maximum head/neck abbreviated injury score (AIS) ≥2, and underwent a neurosurgical procedure within 24 hours. Patients were excluded if they had an AIS ≥3 in other body region or no signs of life at initial evaluation. Main Findings Within the 1,932 patients analyzed, 139 (8.74%) were in the warfarin with or without (+/-) aspirin cohort, 101 (6.35%) in the direct oral anticoagulants (DOAC) +/− aspirin cohort, 169 (10.62%) in the clopidogrel +/− aspirin cohort, and 1,182 (74.29%) in the no AP/AC cohort (control group). After controlling for demographic and clinical characteristics, no significant difference in mortality rates was observed in the treatment groups ( P > 0.05). However, our subgroup analysis did reveal a significantly higher mortality rate within the warfarin and aspirin subgroup when compared to the control group (odds ratio [OR], 2.368; confidence interval [CI], 1.306-4.294, P = 0.005). With regards to hospital complications, there was a significant increase in this outcome within the DOAC +/− aspirin (OR, 1.825; CI, 1.143-2.915, P = 0.012) and clopidogrel +/− aspirin (OR, 1.82; CI, 1.244-2.663, P=0.002) groups. Conclusion Patients on AP/AC who experience a TBI requiring an emergent operation do not have an increased risk of mortality compared to patients not on AP/AC.

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“…It is an undeniable fact that these drugs prepare the ground for the development of subdural hemorrhage. It is reported in the literature that the use of Warfarin increases the risk of subdural hemorrhage by 7-fold, and the use of Dabigatran increases it by 2.4-fold (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

The effects of hematological parameters and anticoagulant/antiaggregant use on surgical outcomes in acute subdural hematoma

Bulduk,

Karaaslan

2023

Med Sci Discov

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Objective: This study aims to investigate the effect of hematologic parameters including International Normalized Ratio (INR), platelet (Plt), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), leukocyte, neutrophil, lymphocyte, C-Reactive Protein (CRP) on the outcomes of surgical treatment of acute subdural hematoma. Material and Methods: The file data of 31 cases who were operated on with the diagnosis of Acute Subdural Hematoma (ASDH) at the Private Ankara Güven Hospital Neurosurgery Clinic between 01.01.2019 and 31.12.2021 were examined retrospectively. The ages, genders, history of anticoagulant/antiaggregant use, INR, platelet, hemoglobin, hematocrit, leukocyte, and CRP values of patients were recorded, and their relationships with re-bleeding, number of surgeries performed, and mortality were evaluated statistically. Results: The study was conducted with a total of 31 cases (35.5% (n=11) female and 64.5% (n=20) male). The average age of the cases was 72 (45-93). A single surgery was performed in 23 cases (74.2%), 8 patients (25.8%) were operated on again because of re-bleeding, and 9 of the cases (29%) died following the surgery. Among the 9 patients who died, 5 (55.5%) underwent single surgery and 4 (44.5%) underwent more than one surgery. The number of cases not using pre-operative anticoagulants/antiaggregants was 10 (32.3%), 9 (29%) patients were using anticoagulants, 7 patients (22.6%) were using single antiaggregant, and 5 patients (16.1%) were using dual antiaggregants. It was detected as statistically significant that the preoperative INR, leukocyte, and neutrophil counts of the patients who underwent multiple surgeries were detected to be higher than those of ASDH patients who underwent single surgery. Conclusion: Although pre-operative INR, leukocyte, and neutrophil elevation are not associated with mortality, these parameters can be associated with the requirement for re-surgery because of re-bleeding. Key words: re-bleeding, subdural hematoma, mortality, leukocyte, neutrophil

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Perioperative Management of Anticoagulation

Cited by 14 publications

References 61 publications

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

Effect of Antiplatelet and Anticoagulant Agents on Outcomes Following Emergent Surgery for Traumatic Brain Injuries

The effects of hematological parameters and anticoagulant/antiaggregant use on surgical outcomes in acute subdural hematoma

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