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Vol. 28. Num. 6.November - December 2017Pages 259-310
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Vol. 28. Num. 6.November - December 2017Pages 259-310
Special article
DOI: 10.1016/j.neucie.2017.08.001
Antithrombotic treatment consensus protocol (anticoagulation and antiplatelet therapy) during the perioperative and periprocedural period in neurosurgery
Protocolo de consenso en el tratamiento antitrombótico (anticoagulación y antiagregación) durante el periodo perioperatorio y periprocedimiento en neurocirugía
Fuat Arikan Abellóa,
Corresponding author
farikan@vhebron.net

Corresponding author.
, Luis Ley Urzaizb, José Fernández Alénc, Rubén Martín Láezd, Grupo de Trabajo de Patología Vascular de la Sociedad Española de Neurocirugía
a Unidad de Investigación de Neurotraumatología-Neurocirugía, Servicio de Neurocirugía, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Servicio de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, Spain
c Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid, Spain
d Servicio de Neurocirugía-Unidad de Raquis Quirúrgico, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Figures (2)
Tables (7)
Table 1. Thrombotic risk stratification for patients treated with oral anticoagulants.
Table 2. CHADS2 score. Predictive score for estimating stroke risk in patients with atrial fibrillation.
Table 3. CHA2DS2-VASC. To complement the CHADS2 score with other stroke risk factors, the CHA2DS2-VASC score was proposed.
Table 4. Thrombotic risk stratification for patients treated with antiplatelet drugs.
Table 5. Bleeding risk stratification of different elective invasive procedures.
Table 6. Bleeding risk stratification of neurosurgical procedures.
Table 7. Guidelines for stopping direct oral anticoagulants based on the compound used, glomerular filtration and bleeding risk.
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Abstract

The use of antithrombotic medication (antiplatelet and/or anticoagulant therapy) is widespread. Currently, the management of neurosurgical patients receiving this type of therapy continues to be a problem of special importance.

Patients receiving antithrombotic treatment may need neurosurgical care because of bleeding secondary to such treatment, non-haemorrhagic neurosurgical lesions requiring urgent attention, or simply elective neurosurgical procedures.

In addition, the consequences of reintroducing early (bleeding or rebleeding) or late (thrombotic or thromboembolic) anticoagulation can be devastating.

In this paper we present the antithrombotic treatment consensus protocol during the perioperative and periprocedural period, both in emergent surgery and in elective neurosurgical procedures.

Keywords:
Antithrombotic treatment
Anticoagulant therapy
Antiplatelet therapy
Haemorrhage risk
Perioperative
Neurosurgery
Resumen

El uso de medicación antitrombótica (antiagregante y/o anticoagulante) se encuentra ampliamente extendido. El manejo de los pacientes neuroquirúrgicos que reciben este tipo de terapia continúa siendo, a día de hoy, un problema de especial importancia.

Los pacientes en tratamiento antitrombótico pueden necesitar atención neuroquirúrgica bien por presentar sangrados secundarios a dicho tratamiento, lesiones neuroquirúrgicas no hemorrágicas pero que precisen intervención urgente, o simplemente procedimientos neuroquirúrgicos electivos.

Además, las consecuencias de la reintroducción de la anticoagulación temprana (sangrado o resangrado) o tardía (trombóticas o tromboembólicas) pueden ser devastadoras.

En este documento presentamos el protocolo de consenso en el tratamiento antitrombótico durante el periodo perioperatorio y periprocedimiento, tanto en cirugía emergente como en procedimientos electivos de neurocirugía.

Palabras clave:
Tratamiento antitrombótico
Anticoagulantes
Antiagregantes
Riesgo hemorragico
Perioperatorio
Neurocirugia

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