Clinical outcomes and hemorrhagic or thromboembolic risks in decompressive craniectomy for patients taking antiplatelet or anticoagulant therapy
Year: 2025
Type: article
Study design: Observational Study
Abstract: Decompressive craniectomy (DC) is a critical surgical intervention for elevated intracranial pressure. However, the impact of preoperative antiplatelet or anticoagulant therapy on outcomes and complications remains unclear. A retrospective-prospective study was conducted on 145 patients undergoing DC between November 2021 and May 2023. Patients were categorized into two groups: those with (n = 48) and without (n = 97) preoperative antithrombotic therapy. Demographic data, comorbidities, antithrombotic therapy type and duration, clinical outcomes, and pre-operative risk factors (CHA2DS2-VASc and HAS-BLED scores) were analyzed. While there was a trend towards higher hemorrhagic complications in the antithrombotic therapy group (20.0% vs. 11.3%), this difference was not statistically significant. However, thromboembolic events, primarily stroke (27.7% vs. 9.3%) and acute myocardial infarction (10.6% vs. 0.0%), were significantly more frequent in the antithrombotic therapy group. Multivariate analysis revealed that ischemic stroke as a primary diagnosis, rather than antithrombotic therapy itself, was a significant predictor of thromboembolic complications (adjusted OR 3.49, 95%CI 1.47-8.28, p = 0.005). Pre-operative GCS was associated with improved outcomes (adjusted OR 0.81, 95%CI 0.67-0.97, p = 0.025). While antithrombotic therapy does not appear to increase the risk of hemorrhagic complications after DC, it is associated with a higher risk of thromboembolic events, especially in patients with ischemic stroke. Individualized assessment and tailored management of antithrombotic therapy are crucial to optimize outcomes in DC patients. Further studies are needed to refine strategies for bridging anticoagulation and managing antithrombotic therapy in this population, considering factors such as CHA2DS2-VASc and HAS-BLED scores, as well as patient-specific risk profiles.
Source: Neurosurgical Review
Authors: Alba Scerrati, Giovanni Scanferla, Lorenzo Sgarbanti, Giorgio Mantovani, Chiara Angelini, Maria Elena Flacco, Rosario Maugeri, Lapo Bonosi, Domenico Gerardo Iacopino, Silvana Tumbiolo, Alessandro Adorno, Lara Brunasso, Giorgio Lofrese, Vittoria Rosetti, Luigino Tosatto, Teresa Somma, Luigi Maria Cavallo, Sara Lombardi, Carmelo Lucio Sturiale, Francesco Signorelli, Anna Maria Auricchio, Grazia Menna, Luca Ricciardi, Nicola Montemurro, Fabio Raneri, Oriela Rustemi, Giampaolo Zambon, Michele Alessandro Cavallo, Pasquale De Bonis
Institutions: University of Ferrara, Arcispedale Sant'Anna, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, University of Palermo, Ospedale “M. Bufalini” di Cesena, Federico II University Hospital, University of Naples Federico II, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Sapienza University of Rome, University of Pisa, Azienda Ospedaliera Universitaria Pisana, Azienda ULSS 8 Berica
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,590
OpenAlex ID: W4408921625