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Survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy in neurosurgery

  • Original Article - Neurosurgery general
  • Published:
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Abstract

Background

A growing number of patients on anticoagulation or antiplatelet therapy (APT) are planned for elective surgery. The management of perioperative anticoagulation and APT is challenging because it must balance the risk of thromboembolism and bleeding, and specific recommendations for the management of bridging in neurosurgical patients are lacking. We surveyed German neurosurgical centers about their management of perioperative bridging of anticoagulation and APT to provide an overview of the current bridging policy.

Method

From April to August 2016, all German neurosurgical departments were invited to participate in the survey. We used SurveyMonkey to compose ten questions and to conduct the survey, and we defined three different approaches for the perioperative management of patients on a preexisting medication: medication will be discontinued (A) with perioperative “bridging” and (B) without perioperative bridging, or (C) medication will be continued perioperatively.

Results

Out of 141 respondents, 84 (60%) partially and 77 (55%) fully completed the questionnaire. No defined policy for the perioperative management of anticoagulation and APT was established in 60.7% (51/84) of participating centers. The perioperative management of anticoagulation and APT varied widely among different centers in all items of the questionnaire; for example, in the group of patients at high risk for thromboembolism, acetylsalicylic acid was discontinued in 22%, bridged in 35%, and continued in 35% of centers.

Conclusions

There is significant uncertainty regarding the management of perioperative bridging of anticoagulation and APT in neurosurgery because of a lack of prospective and limited retrospective data.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Marco Skardelly, Lisa Mönch, Constantin Roder, Konstantin Hockel, Marcos Soares Tatagiba & Florian H. Ebner

  2. Interdisciplinary Division of Neuro-Oncology, Departments of Vascular Neurology and Neurosurgery, University Hospital Tuebingen, Eberhard Karls University of Tübingen, Hertie Institute for Clinical Brain Research, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Marco Skardelly, Constantin Roder, Marcos Soares Tatagiba & Florian H. Ebner

  3. Neuro-Oncology Center, Comprehensive Cancer Center Tübingen, University Hospital Tuebingen, Eberhard Karls University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany

    Marco Skardelly, Constantin Roder, Marcos Soares Tatagiba & Florian H. Ebner

Authors
  1. Marco Skardelly
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  2. Lisa Mönch
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  3. Constantin Roder
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  4. Konstantin Hockel
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  5. Marcos Soares Tatagiba
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  6. Florian H. Ebner
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Corresponding author

Correspondence to Marco Skardelly.

Ethics declarations

The institutional ethics committee of the medical faculty of our university decided that approval was not necessary, because the survey questioned the current practice of anticoagulation and APT in neurosurgical centers but did not investigate patient-related data (327/2016A).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

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Comments

In my opinion, Skardelly and co-workers provide an interesting and important "survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy" in German neurosurgical centers. The limitations of the study have been seen and adequately discussed by the authors, especially the fact that the study did not differentiate between therapeutic and low-dose bridging.

Marcus Reinges

Bremen, Germany

This article is part of the Topical Collection on Neurosurgery General

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Skardelly, M., Mönch, L., Roder, C. et al. Survey of the management of perioperative bridging of anticoagulation and antiplatelet therapy in neurosurgery. Acta Neurochir 160, 2077–2085 (2018). https://doi.org/10.1007/s00701-018-3679-5

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  • DOI: https://doi.org/10.1007/s00701-018-3679-5

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