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20.09.2018 | Original Article - Neurosurgery general | Ausgabe 11/2018

Acta Neurochirurgica 11/2018

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

Zeitschrift:
Acta Neurochirurgica > Ausgabe 11/2018
Autoren:
Marco Skardelly, Lisa Mönch, Constantin Roder, Konstantin Hockel, Marcos Soares Tatagiba, Florian H. Ebner
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-018-3679-5) contains supplementary material, which is available to authorized users.
This article is part of the Topical Collection on Neurosurgery General
Presentation at a conference
Part of the survey was presented at the 69th Annual Meeting of the German Society of Neurosurgery.
Comments
In my opinion, Skardelly and co-workers provide an interesting and important "survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy" in German neurosurgical centers. The limitations of the study have been seen and adequately discussed by the authors, especially the fact that the study did not differentiate between therapeutic and low-dose bridging.
Marcus Reinges
Bremen, Germany

Abstract

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.

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