Alessandro Prior1, Pietro Fiaschi2,3, Corrado Iaccarino4, Roberto Stefini5, Denise Battaglini6,7, Alberto Balestrino1, Pasquale Anania1, Enrico Prior8, Gianluigi Zona1,9. 1. Section of Neurosurgery, Department of Neuroscience (DINOGMI) IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 2. Section of Neurosurgery, Department of Neuroscience (DINOGMI) IRCCS Ospedale Policlinico San Martino, Genoa, Italy. pietro.fiaschi@alice.it. 3. Università di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 1016132, Genoa, Italy. pietro.fiaschi@alice.it. 4. Department of Neurosurgery, University Hospital, Parma, Italy. 5. Department of Neurosurgery, Ospedale Civile di Legnano, Milan, Italy. 6. Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy. 7. Department of Medicine, University of Barcelona, Barcelona, Spain. 8. Division of Cardiology, Department of Medicine University of Verona, Verona, Italy. 9. Università di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 1016132, Genoa, Italy.
Abstract
BACKGROUND: Anticoagulant assumption is a concern in neurosurgical patient that implies a delicate balance between the risk of thromboembolism versus the risk of peri- and postoperative hemorrhage. METHODS: We performed a survey among 129 different neurosurgical departments in Italy to evaluate practice patterns regarding the management of neurosurgical patients taking anticoagulant drugs. Furthermore, we reviewed the available literature, with the aim of providing a comprehensive but practical summary of current recommendations. RESULTS: Our survey revealed that there is a lack of knowledge, mostly regarding the indication and the strategies of anticoagulant reversal in neurosurgical clinical practice. This may be due a lack of national and international guidelines for the care of anticoagulated neurosurgical patients, along with the fact that coagulation and hemostasis are not simple topics for a neurosurgeon. CONCLUSIONS: To overcome this issue, establishment of hospital-wide policy concerning management of anticoagulated patients and developed in an interdisciplinary manner are strongly recommended.
BACKGROUND: Anticoagulant assumption is a concern in neurosurgical patient that implies a delicate balance between the risk of thromboembolism versus the risk of peri- and postoperative hemorrhage. METHODS: We performed a survey among 129 different neurosurgical departments in Italy to evaluate practice patterns regarding the management of neurosurgical patients taking anticoagulant drugs. Furthermore, we reviewed the available literature, with the aim of providing a comprehensive but practical summary of current recommendations. RESULTS: Our survey revealed that there is a lack of knowledge, mostly regarding the indication and the strategies of anticoagulant reversal in neurosurgical clinical practice. This may be due a lack of national and international guidelines for the care of anticoagulated neurosurgical patients, along with the fact that coagulation and hemostasis are not simple topics for a neurosurgeon. CONCLUSIONS: To overcome this issue, establishment of hospital-wide policy concerning management of anticoagulated patients and developed in an interdisciplinary manner are strongly recommended.
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