Managing Antiplatelets and Anticoagulants following Craniotomy for Tumor Resection: A Survey of Board-Certified Neurosurgeons

Introduction: Around 250,000 patients with chronic antiplatelets or anticoagulation therapy due to an underlying cardio- or cerebrovascular disease undergo elective neurosurgical procedures annually. The data in regard to preoperative cessation and postoperative resumption of those medications is scarce, and the management continues to be driven by the surgeon's experience and personal preference. The purpose of this study is to provide a better perspective into the practice patterns and shed light on this critical and controversial issue.

Methods: An online survey was created using Google Forms and was then distributed to 1,500 board-certified neurosurgeons in the United States. The survey was kept open for 2 weeks with one reminder sent after the first week.

Results: A total of 370 board-certified neurosurgeons (24.7%) who mostly have been in practice for < 15 years responded to the survey. Eighty-six percent of responders who always hold aspirin before elective brain tumor resection were compared. A total of 82% of responders restart at least one antiplatelet (aspirin or clopidogrel) within the first 7 days following uncomplicated elective craniotomy for tumor resection. On the other hand, 65.7% of responders restart anticoagulants within the first 7 days following uncomplicated elective craniotomy for tumor resection. While most responders restart antiplatelets and anticoagulation on postoperative day 7, the mean day to restart those medications was significantly lower by responders with longer years in practice following elective brain tumors resection.

Conclusion: This study highlights the variation in practice between neurosurgeons in managing antithrombotic medications before and after elective brain tumor resection. Because of the lack evidence-based guidelines, further studies are needed to make a risk–benefit analysis that balances the urgency of antithrombosis against the perceived risk of hemorrhage.

Publication History

Article published online:
12 February 2021