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Role of Antiplatelet Therapy in Neurosurgery: Efficacy and Safety Profiles

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Anticoagulation and Hemostasis in Neurosurgery

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Abstract

Antiplatelet therapies are prescribed to reduce stent stenosis and prevent vascular events. However, antiplatelet therapy comes with risks because increased bleeding can occur. These risks are amplified in neurosurgery because the brain is highly vascular and is in a closed system. Small disruptions in the normal homeostasis of the brain can lead to disastrous consequences. It may be difficult to determine if discontinuing antiplatelet prior to surgery or continuing antiplatelet therapy through surgery is the best choice. To assist with this dilemma, a review of surgical guidelines and antiplatelet use is provided here. Currently, there is controversy regarding the role of antiplatelet therapy in hematoma expansion due to trauma or spontaneous intracranial hemorrhage. Also there is controversy about the usefulness of platelet transfusions in reducing mortality in patients with prior antiplatelet therapy utilization prior to spontaneous and traumatic hemorrhages. To help clarify these controversies, this chapter summarizes studies that have investigated these topics. We focus primarily on aspirin and clopidogrel because they are two of the most frequently used antiplatelets and have the most data available. Additionally, this chapter highlights the latest advances in antiplatelet therapy.

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  1. The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, 12144, USA

    Nicholas Bowen PharmD & Shaker A. Mousa PhD, MBA, FACC, FACB

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    Christopher M. Loftus

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Bowen, N., Mousa, S.A. (2016). Role of Antiplatelet Therapy in Neurosurgery: Efficacy and Safety Profiles. In: Loftus, C. (eds) Anticoagulation and Hemostasis in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27327-3_6

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