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Coagulation management in patients undergoing neurosurgical procedures
Chiara Robba1, Rita Bertuetti, Frank Rasulo
1aDepartment of Neurocritical Care Unit, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom bDepartment of Neurointensive Care, Spedali Civili Brescia, Brescia, Italy cDepartment of Neurosurgery, St. George's Hospital, London, United Kingdom.
Current Opinion in Anaesthesiology
|July 19, 2017
Summary
Managing coagulation during neurosurgery is critical to prevent bleeding. This review examines new evidence on managing anticoagulated patients undergoing craniotomy, balancing bleeding and clotting risks.
Area of Science:
- Neurosurgery
- Coagulation Medicine
- Anesthesiology
Background:
- Neurosurgical procedures present unique coagulation challenges, with risks of intracranial bleeding.
- Perioperative bleeding is influenced by anticoagulants, patient coagulation status, and the nature of the intracranial disorder.
Purpose of the Study:
- To review current evidence on managing coagulation in patients undergoing craniotomy for neurosurgical procedures.
- To focus on new data concerning anticoagulated patients and novel anticoagulant drugs.
Main Methods:
- Review of current clinical trials and literature.
- Analysis of safety and efficacy data for deep venous thrombosis prophylaxis in neurosurgical patients.
- Consideration of patients undergoing elective surgery, intensive care, severe traumatic brain injury, and multiple traumas.
Main Results:
- Antihemostatic and anticoagulant drugs are linked to perioperative bleeding.
- A hypercoagulable state and increased risk of venous thromboembolism are observed post-neurosurgery, especially after brain tumor surgery.
- Balancing thrombosis and bleeding risks requires understanding perioperative coagulation changes and updated management guidelines, particularly for direct oral anticoagulants.
Conclusions:
- Coagulation management is a significant challenge in neurosurgery.
- The current literature quality is limited, necessitating further research.
- Identifying optimal strategies to minimize risks for neurosurgical patients requires more robust studies.
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