gms | German Medical Science

Objective: Neurosurgeons are increasingly confronted with patients on anticoagulation or antiplatelet therapy. For elective surgery of these patients, perioperative management is challenging because both the risk of bleeding and the risk of development of thromboembolism have to be considered. Since prospective studies are missing and retrospective data are limited and contradictory, we performed a survey in German neurosurgical departments to give an overview of prevailing bridging practices.

Methods: All German neurosurgical centers were invited to complete an online-survey on SurveyMonkey of ten questions about the topic of bridging management of anticoagulation or antiplatelet therapy (APT). The management of preexisting anticoagulation or APT was divided into a) continue medication, b) stop medication with bridging and c) stop medication without bridging. Risk groups for cardiovascular events and thromboembolisms were determined analogous the guidelines of the American College of Chest Physicians (2012).

Results: The survey was completed by 55% (77/141) and partially completed by 60% (84/141) of all participants. In 60.7% (51/84) of participating centers no clinical policy was available for the bridging of anticoagulation or APT. We observed a broad variety of bridging practices among different neurosurgical centers in most items of the survey. In some items the chance to be managed by continuing (a), bridging (b) or discontinuing (c) was very similar; e.g. in the group of high risk for thromboembolism APT was continued in 35%, bridged in 35% and discontinued in 22%.

Conclusion: The management of perioperative bridging of anticoagulation or APT in neurosurgery is not well established. Reasons might be missing prospective and contradictory retrospective data but also different experience of the participating neurosurgical centers.