Key result
Perioperative review advises continuing aspirin but holding P2Y12 inhibitors and DOACs without routine warfarin bridging.
Why the study?
Neurosurgery patients on antiplatelet or anticoagulation require a balance between bleeding and thromboembolic risks, as even minor over-bleeding can be irreversible and fatal.
How should antiplatelet and anticoagulant therapy be managed perioperatively in neurosurgical patients to balance bleeding and thromboembolic risks?
How should antiplatelet and anticoagulant therapy be managed perioperatively in neurosurgical patients to balance bleeding and thromboembolic risks?
This review provides a systematic, evidence-based approach for the perioperative management of antiplatelet and anticoagulant therapies in neurosurgical patients to balance bleeding and thrombotic risks.
Answers are grounded in this paper and cite their sources.
Guides perioperative antithrombotic decisions in neurosurgery; leaves open prospective validation of recommended discontinuation intervals.
Background: For neurosurgery patients on antiplatelet or anticoagulation, there is a critical balance to be struck between the risks of bleeding and thromboembolic complications. A crucial distinction must be made, as the effects of even a small amount of over-bleeding are irreversible and fatal. Key Findings: Aspirin can safely be continued for certain types of cranial or spinal procedures. P2Y12 inhibitors will need to be discontinued 5-10 days before operation. For Warfarin patients, the goal is an INR <1.4, and bridging is only recommended in extreme situations of thrombotic risk. All DOACs should be discontinued 48-72 hours before procedure, but emergency reversal is available if necessary (idarucizumab and andexanet alfa). Routine bridging anticoagulation should generally not be utilized. Conclusion: Multidisciplinary, individualized decision making is necessary in each perioperative neurosurgical case; by accounting for the risks of bleeding from specific procedures versus individual thrombotic risks to a specific patient, one can provide adequate care. This review aims to offer a systematic evidence based approach to such a dilemma. Keywords: anticoagulants; antiplatelet; neurosurgery; perioperative management; intracranial haemorrhage; bridging anticoagulation; DOAC reversal. Title: Perioperative Management of Antiplatelet and Anticoagulant Therapy in Neurosurgical Patients: A Practical Review with Evidence-Based Flow Chart Author: Dr. Rathikinda Srinivasulu, Dr Saurabh Patel International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 14, Issue 1, April 2026 - September 2026 Page No: 145-152 Research Publish Journals Website: www.researchpublish.com Published Date: 01-June-2026 DOI: https://doi.org/10.5281/zenodo.20486045 Paper Download Link (Source) https://www.researchpublish.com/papers/perioperative-management-of-antiplatelet-and-anticoagulant-therapy-in-neurosurgical-patients-a-practical-review-with-evidence-based-flow-chart
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Srinivasulu et al. (2026) conducted a review in Neurosurgical patients on antiplatelet or anticoagulation therapy. Perioperative management of antiplatelet and anticoagulant therapy was evaluated.
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