Survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy in neurosurgery

Background A growing number of patients on anticoagulation or antiplatelet therapy (APT) are planned for elective surgery. The management of perioperative anticoagulation and APT is challenging because it must balance the risk of thromboembolism and bleeding, and specific recommendations for the man...

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Bibliographic Details
Published in:	Acta neurochirurgica Vol. 160; no. 11; pp. 2077 - 2085
Main Authors:	Skardelly, Marco, Mönch, Lisa, Roder, Constantin, Hockel, Konstantin, Tatagiba, Marcos Soares, Ebner, Florian H.
Format:	Journal Article
Language:	English
Published:	Vienna Springer Vienna 01-11-2018 Springer Nature B.V
Subjects:	Acetylsalicylic acid Anticoagulants Antiplatelet therapy Bridging Disease management Interventional Radiology Medicine Medicine & Public Health Minimally Invasive Surgery Neurology Neuroradiology Neurosurgery Neurosurgery general Original Article - Neurosurgery general Surgery Surgical Orthopedics Thromboembolism Antiplatelet therapy Perioperative Survey Anticoagulation Bridging
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Summary:	Background A growing number of patients on anticoagulation or antiplatelet therapy (APT) are planned for elective surgery. The management of perioperative anticoagulation and APT is challenging because it must balance the risk of thromboembolism and bleeding, and specific recommendations for the management of bridging in neurosurgical patients are lacking. We surveyed German neurosurgical centers about their management of perioperative bridging of anticoagulation and APT to provide an overview of the current bridging policy. Method From April to August 2016, all German neurosurgical departments were invited to participate in the survey. We used SurveyMonkey to compose ten questions and to conduct the survey, and we defined three different approaches for the perioperative management of patients on a preexisting medication: medication will be discontinued (A) with perioperative “bridging” and (B) without perioperative bridging, or (C) medication will be continued perioperatively. Results Out of 141 respondents, 84 (60%) partially and 77 (55%) fully completed the questionnaire. No defined policy for the perioperative management of anticoagulation and APT was established in 60.7% (51/84) of participating centers. The perioperative management of anticoagulation and APT varied widely among different centers in all items of the questionnaire; for example, in the group of patients at high risk for thromboembolism, acetylsalicylic acid was discontinued in 22%, bridged in 35%, and continued in 35% of centers. Conclusions There is significant uncertainty regarding the management of perioperative bridging of anticoagulation and APT in neurosurgery because of a lack of prospective and limited retrospective data.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0001-6268 0942-0940
DOI:	10.1007/s00701-018-3679-5