The effect of antiplatelet and anticoagulant therapies on clinical outcome of patients undergoing decompressive...

Area of Science:

• Neurosurgery
• Pharmacology
• Critical Care Medicine

Background:

• Decompressive craniectomy (DC) is a critical procedure for managing severe brain injuries.
• The use of antiplatelet (AP) and anticoagulant (AC) agents in patients undergoing DC requires careful consideration due to potential bleeding risks.
• Understanding the impact of APs/ACs on perioperative complications and neurological outcomes is crucial for patient management.

Approach:

• A systematic review was conducted using PubMed and Science Direct to identify relevant studies.
• Four studies were selected after screening titles, abstracts, and full texts.
• The review focused on perioperative complications, particularly hemorrhagic events, and neurological outcomes in patients on APs/ACs versus those not.

Key Points:

• Administration of APs/ACs did not significantly impact functional outcomes in patients undergoing DC.
• Fewer instances of rebleeding within six months and other complications, such as infections, were observed in patients taking APs compared to those not on APs/ACs.
• The available data showed considerable heterogeneity and insufficient volume for robust statistical analysis.

Conclusions:

• A definitive conclusion on the influence of suspending or continuing APs/ACs in DC patients cannot be confidently reached due to data limitations.
• A large-scale prospective study is warranted to gather substantial data on balancing the risks and benefits of APs/ACs in the context of DC.
• Further research is needed to provide a nuanced understanding of AP/AC management during decompressive craniectomy.