Perioperative Management of Anticoagulation.
Antiplatelet and anticoagulant drugs (antithrombotics) predispose to acute and chronic subdural hematomas. Patients on these drugs are at higher likelihood of presenting with larger hematomas and more severe neurologic deficits. Standard neurosurgical and neurocritical care of subdural hematomas involves reversal of antithrombosis preoperatively, whereas reversing antiplatelet drugs is less clear. This article highlights the spectrum of antithrombotic agents in common use, their mechanisms of action, and strategies for reversal.
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, West Wing, 4th Floor, Toronto, Ontario M5T 2S8, Canada.
Daipayan
D
Guha
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, West Wing, 4th Floor, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Electronic address: macdonaldlo@smh.ca.
R Loch
RL
Macdonald
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001777:Blood Coagulation; D001792:Blood Platelets / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D020200:Hematoma, Subdural, Chronic / Q000628:therapy*; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D012307:Risk Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents
Anticoagulation; Antiplatelet; Bleeding; Subdural hematoma; Thrombosis