{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T03:13:11Z","timestamp":1785726791104,"version":"3.56.0"},"reference-count":68,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Discontinuation of antithrombotics (AT) prior to elective cranial procedures is common practice, despite the higher risk of thromboembolic complications in these patients. The aim of this study was to investigate the risks and benefits of a new perioperative management protocol of continuation or ultra-early AT resumption in elective cranial procedures.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This study was an analysis of a prospectively collected cohort of patients undergoing elective cranial surgery with (AT group) and without (control group) AT. For extraaxial or shunt surgeries, acetylsalicylic acid (ASA) was continued perioperatively. For intraaxial pathologies, ASA was discontinued 2 days before surgery and resumed on postoperative day 3. All other AT were discontinued according to their pharmacokinetics, and resumed on postoperative day 3 after unremarkable postoperative imaging. Additionally, the authors performed a retrospective analysis of patients with AT who underwent surgery before implementation of this new AT management protocol (historical AT group). Primary and secondary outcomes were the incidence of hemorrhagic and thromboembolic complications within 3 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Outcomes of 312 patients were analyzed (83 [27%] in the AT group, 106 [34%] in the control group, and 123 [39%] in the historical AT group). For all 3 patient groups, the most common type of surgery was craniotomy for intraaxial tumors (14 [17%] in the AT group, 28 [26%] in the control group, and 60 [49%] in the historical AT group). The most commonly used AT were ASA (38 [46%] in the AT group and 78 [63%] in the historical AT group), followed by non\u2013vitamin K oral anticoagulants (32 [39%] in the AT group and 18 [15%] in the historical AT group). The total perioperative discontinuation time in the AT group was significantly shorter than in the historical AT group (median of 4 vs 16 days; p < 0.001). The rate of hemorrhagic complications was 4% (95% CI 1\u201310) (n = 3\/83) in the AT group, 6% (95% CI 2\u201312) (n = 6\/106) in the control group, and 7% (95% CI 3\u201313) (n = 9\/123) in the historical AT group (p = 0.5). The rate of thromboembolic complications was 5% (95% CI 1\u201312) (n = 4\/82) in the AT group, 8% (95% CI 3\u201315) (n = 8\/104) in the control group, and 7% (95% CI 3\u201313) (n = 8\/120) in the historical AT group (p = 0.7).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The presented perioperative management protocol of continuation or ultra-early resumption of AT in elective cranial procedures does not seem to increase the hemorrhagic risk. Moreover, it appears to potentially protect patients from thromboembolic complications.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.7.focus23357","type":"journal-article","created":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T09:23:40Z","timestamp":1696152220000},"page":"E6","source":"Crossref","is-referenced-by-count":10,"title":["Perioperative continuation or ultra-early resumption of antithrombotics in elective neurosurgical cranial procedures"],"prefix":"10.3171","volume":"55","author":[{"given":"Jonathan","family":"Rychen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin F.","family":"Weiger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian S.","family":"Halbeisen","sequence":"additional","affiliation":[{"name":"Surgical Outcome Research Center Basel,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Ebel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel","family":"Ullmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Mariani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"},{"name":"Faculty of Medicine, University of Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Guzman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"},{"name":"Faculty of Medicine, University of Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehuda","family":"Soleman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery,"},{"name":"Department of Clinical Studies, University Hospital of Basel; and"},{"name":"Faculty of Medicine, University of Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Neurosurgery","first-page":"1061","article-title":"Postoperative hematoma: a 5-year survey and identification of avoidable risk factors","volume":"35","author":"Palmer JD","year":"1994","unstructured":"Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35(6):1061\u20131065."},{"issue":"11","key":"b2","series-title":"Acta Neurochir (Wien)","first-page":"1189","article-title":"Low-dose aspirin before intracranial surgery\u2014results of a survey among neurosurgeons in Germany","volume":"148","author":"Korinth MC","year":"2006","unstructured":"Korinth MC. Low-dose aspirin before intracranial surgery\u2014results of a survey among neurosurgeons in Germany. Acta Neurochir (Wien). 2006;148(11):1189\u20131196."},{"key":"b3","series-title":"Article. World Neurosurg","first-page":"778","article-title":"The management of patients with chronic subdural hematoma treated with low-dose acetylsalicylic acid: an international survey of practice","volume":"107","author":"Soleman J","year":"2017","unstructured":"Soleman J, Kamenova M, Guzman R, Mariani L. The management of patients with chronic subdural hematoma treated with low-dose acetylsalicylic acid: an international survey of practice. Article. World Neurosurg. 2017;107:778\u2013788."},{"key":"b4","series-title":"Acta Anaesthesiol Scand","first-page":"53","article-title":"Postoperative haemorrhages requiring surgical treatment in neurosurgery","volume":"59","author":"Lillemae K","year":"2015","unstructured":"Lillemae K, Jarvio JA, Silvasti-Lundell MK, Postoperative haemorrhages requiring surgical treatment in neurosurgery. Acta Anaesthesiol Scand. 2015;59:53."},{"key":"b5","series-title":"BMJ","first-page":"d4094","article-title":"Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care","volume":"343","author":"Rodr\u00edguez LA","year":"2011","unstructured":"Rodr\u00edguez LA, Cea-Soriano L, Mart\u00edn-Merino E, Johansson S. Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care. BMJ. 2011;343:d4094."},{"issue":"8","key":"b6","series-title":"Neurology","first-page":"740","article-title":"Increased risk of stroke after discontinuation of acetylsalicylic acid: a UK primary care study","volume":"76","author":"Garc\u00eda Rodr\u00edguez LA","year":"2011","unstructured":"Garc\u00eda Rodr\u00edguez LA, Cea Soriano L, Hill C, Johansson S. Increased risk of stroke after discontinuation of acetylsalicylic acid: a UK primary care study. 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Does the discontinuation time of antiplatelet or anticoagulation treatment affect hemorrhagic complications in patients undergoing craniotomy for neurovascular lesions? Br J Neurosurg. 2021;35(5):619\u2013624."},{"issue":"10","key":"b16","series-title":"Circulation","first-page":"1206","volume":"101","author":"Awtry EH","year":"2000","unstructured":"Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101(10):1206\u20131218."},{"issue":"1","key":"b17","series-title":"Thromb Res","first-page":"99","article-title":"Dosage frequency for suppression of platelet function by low dose aspirin therapy","volume":"27","author":"Bradlow BA","year":"1982","unstructured":"Bradlow BA, Chetty N. Dosage frequency for suppression of platelet function by low dose aspirin therapy. 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Acta Neurochir (Wien). 2023;165(1):39\u201347."},{"issue":"5","key":"b20","series-title":"J Neurosurg","first-page":"1529","article-title":"Effect of perioperative aspirin use on hemorrhagic complications in elective craniotomy for brain tumors: results of a single-center, retrospective cohort study","volume":"132","author":"Hanalioglu S","year":"2019","unstructured":"Hanalioglu S, Sahin B, Sahin OS, Effect of perioperative aspirin use on hemorrhagic complications in elective craniotomy for brain tumors: results of a single-center, retrospective cohort study. J Neurosurg. 2019;132(5):1529\u20131538."},{"issue":"1","key":"b21","series-title":"World Neurosurg","first-page":"41","article-title":"Effects of perioperative acetyl salicylic acid on clinical outcomes in patients undergoing craniotomy for brain tumor","volume":"84","author":"Rahman M","year":"2015","unstructured":"Rahman M, Donnangelo LL, Neal D, Mogali K, Decker M, Ahmed MM. 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