title: The Effect of Preoperative Antiplatelet Therapy on Hemorrhagic Complications after Decompressive Craniectomy in Patients with Traumatic Brain Injury.
abstract: OBJECTIVE
  Traditionally, it is generally recommended that antiplatelet agent should be discontinued before surgery. However, decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) is performed emergently in most cases. Therefore, DC cannot be delayed to the time when the effect of antiplatelet agent on bleeding tendency dissipates. In this study, we evaluated the effect of preinjury antiplatelet therapy on hemorrhagic complications after emergent DC in patients with TBI.
  
  
  METHODS
  We retrospectively investigated patients with TBI who underwent emergent DC between 2006 and 2015. The patients were separated into two groups according to the use of preinjury antiplatelet agent: group 1 (patients taking antiplatelet agent) and group 2 (patients not taking antiplatelet agent). The rate of hemorrhagic complications (postoperative epidural or subdural hemorrhage, newly developed, or progression of preexisting contusion or intracerebral hemorrhage within the field of DC) and the rate of reoperation within 7 days after DC were compared between two groups.
  
  
  RESULTS
  During the study period, DC was performed in 90 patients. Of them, 19 patients were taking antiplatelet agent before TBI. The rate of hemorrhagic complications was 52.6% (10/19) in group 1 and 46.5% (33/71) in group 2 (p=0.633). The rate of reoperation was 36.8% (7/19) in group 1 and 36.6% (26/71) in group 2 (p=0.986). No statistical difference was found between two groups.
  
  
  CONCLUSIONS
  Preinjury antiplatelet therapy did not influence the rate of hemorrhagic complications and reoperation after DC. Emergent DC in patients with TBI should not be delayed because of preinjury antiplatelet therapy.
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Hokyun
authors.initials: H
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Koh
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Hyunho
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Byong-Cheol
authors.initials: BC
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Seung Yeob
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, Korea.
authors.forename: Keun-Tae
authors.initials: KT
authors.lastname: Cho
keywords: Brain injuries; Decompressive craniectomy; Platelet aggregation inhibitors; Postoperative hemorrhage