Safety of continuing antithrombotic therapy during lumboperitoneal shunting for idiopathic normal pressure hydrocephalus: A single-center retrospective analysis.

BACKGROUND: The perioperative management of antithrombotic (AT) therapy during lumboperitoneal shunting (LPS) for idiopathic normal pressure hydrocephalus (iNPH) remains controversial, and evidence to guide decisions regarding continuation of AT therapy is limited. METHODS: We retrospectively analyzed patients with iNPH who underwent LPS at our institution. Patients were classified according to AT agent use on the day of surgery into a Continued AT therapy group and a Discontinued/No AT therapy group. Symptomatic hemorrhagic complications, chronic subdural hematoma (CSDH), and thromboembolic events within 1 month after surgery were evaluated. RESULTS: A total of 203 patients were included in the analysis, of whom 164 (80.8%) were classified into the Discontinued/No AT therapy group and 39 (19.2%) into the Continued AT therapy group. Symptomatic hemorrhagic complications excluding CSDH occurred in 2 patients (1.2%) in the Discontinued/No AT therapy group and in 1 patient (2.6%) in the Continued AT therapy group (odds ratio [OR], 2.13; 95% confidence interval [CI], 0.19-24.1). CSDH developed in 8 patients (4.9%) in the Discontinued/No AT therapy group and in 2 patients (5.1%) in the Continued AT therapy group (OR, 1.05; 95% CI, 0.21-5.17). Symptomatic thromboembolic complications occurred in 1 patient (0.6%) in the Discontinued/No AT therapy group and in none of the patients who continued AT therapy. CONCLUSIONS: The overall incidence of hemorrhagic complications was low in both groups, regardless of AT agent use. These findings demonstrate the rarity of such events, which presents a fundamental obstacle to conducting adequately powered prospective trials on perioperative antithrombotic management in this population.