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Updated: Mar 28, 2026
Performing Intracochlear Electrocochleography During Cochlear Implantation
Published on: March 8, 2022
Cochlear Implantation in the Setting of Perioperative Anticoagulation and Antiplatelet Therapy
Jacob B Hunter1, Matthew L Carlson2, Alex D Sweeney3
1The Otology Group, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA jacob.b.hunter@vanderbilt.edu.
Insights
Continuing antiplatelet or anticoagulation therapy during cochlear implantation surgery is safe. This study found a low risk of complications, making it an appropriate strategy for patients at risk of serious adverse events from stopping these medications.
Area of Science:
- Otolaryngology
- Cardiology
- Neurosurgery
Background:
- Cochlear implantation is a complex surgical procedure.
- Patients undergoing cochlear implantation may require antiplateplatelet or anticoagulation therapy for other medical conditions.
- The decision to continue or discontinue these medications perioperatively involves balancing the risk of surgical complications against the risk of thrombotic events.
Purpose of the Study:
- To evaluate surgical outcomes and perioperative complications in patients undergoing cochlear implantation while on antiplatelet and/or anticoagulation therapy.
- To determine the safety and appropriateness of continuing these medications during the perioperative period.
Main Methods:
- Retrospective case series with chart review.
- Analysis of 46 adult patients who underwent cochlear implantation between 2005 and 2014.
- Patients continued perioperative antiplatelet and/or anticoagulation therapy without interruption.
Main Results:
- No major intraoperative or postoperative complications were attributed to antiplatelet or anticoagulant use.
- Minor complications included postoperative bruising (6.5%) and self-resolving oral cavity blood (2.2%).
- The majority of patients tolerated continued therapy without significant bleeding events.
Conclusions:
- Continuing antiplatelet or anticoagulation therapy during cochlear implantation is associated with a low risk of perioperative complications.
- This strategy is appropriate for patients at high risk of thrombotic events (e.g., deep venous thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident) if medications are stopped.
- The findings support maintaining these therapies to prevent serious adverse events in at-risk populations.
Objective:
To describe surgical outcomes and perioperative complications in patients taking antiplatelet and anticoagulation medications while undergoing cochlear implantation.
Study Design:
Case series with chart review.
Setting:
Two tertiary otologic referral center.
Subjects And Methods:
Forty-six adult patients (2005-2014) who underwent cochlear implantation while on perioperative antiplatelet and/or anticoagulation therapy without interruption. Outcomes included estimated intraoperative blood loss, perception of increased difficulty secondary to bleeding, and postoperative complications attributable to continuing anticoagulation or antiplatelet therapy.
Results:
The cases of 46 patients (mean age, 69.5 years; 30.2% female) were analyzed. Of these, 39 patients were taking aspirin, 10 warfarin, and 7 clopidogrel. Aside from 3 (6.5%) patients with postoperative bruising without hematoma and 1 patient (2.2%) who reported self-resolving oral cavity blood, no intraoperative or postoperative complications occurred in any patient that could be ascribed to antiplatelet or anticoagulant use.
Conclusion:
These data demonstrate that the risk of perioperative complications from continued antiplatelet or anticoagulation therapy is low. For subjects who are at risk of major complications (eg, deep venous thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident) from temporary medication cessation, continuing antiplatelet or anticoagulation therapy through the perioperative period is an appropriate strategy.
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