title: Survey of neurosurgical management of central nervous system hemorrhage in patients receiving anticoagulation therapy: current practice is highly variable and may be suboptimal.
abstract: BACKGROUND
  Patients with central nervous system (CNS) hemorrhage who receive anticoagulation (AC) therapy are at high risk for progressive or recurrent hemorrhagic and thromboembolic (TE) events. The authors conducted a survey at the 2010 American Association of Neurological Surgeons (AANS) annual meeting to determine how these patients are currently being managed by neurosurgeons.
  
  
  METHODS
  During plenary session III at the 2010 AANS annual meeting, the audience was presented with an illustrative case and surveyed with an audience response system. The number choosing each response as well as data regarding the level of training of meeting registrants were provided to the authors by the AANS.
  
  
  RESULTS
  Approximately 10% of all meeting registrants responded to the questions, 65% of whom were consultant neurosurgeons. The responses showed that 47.7% of respondents face dilemmas regarding AC restart time and intensity at least once per week. The most commonly selected AC restart time was 1 month after the index hemorrhage (43.5%); 8.0% indicated they would not restart AC. In making management decisions in these patients, 59.4% of respondents indicated that they relied predominantly on their own intuition or past experience.
  
  
  CONCLUSIONS
  This study is the first to describe how patients with CNS hemorrhage who receive AC therapy are currently being managed by clinicians. An apparent neurosurgical preference to avoid hemorrhagic complications is at odds with a suggested early risk for TE. These data suggest that the neurosurgical management of patients with CNS hemorrhage who receive AC therapy is an area that could benefit from consensus-based practice guidelines and an organized effort at knowledge translation and mobilization.
authors: Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
authors: Gregory W J
authors: GW
authors: Hawryluk
authors: Julio C
authors: JC
authors: Furlan
authors: James W
authors: JW
authors: Austin
authors: Michael G
authors: MG
authors: Fehlings
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D002493:Central Nervous System Diseases / Q000601:surgery*; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D020300:Intracranial Hemorrhages / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012306:Risk; D018570:Risk Assessment; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants