Introduction: The number of patients treated with NOACS is increasing. Despite growing clinical relevance, guidelines on the perioperative management of neurosurgical patients treated with NOACS are still lacking. The aim of this study was to analyze the occurrence of postoperative bleeding events and factors which might influence bleeding rates of these patients.
Methods: Out of 1353 consecutive patients undergoing cranial neurosurgical procedures 30 patients (2.2%) were under NOACS preoperatively. In addition to the descriptive review of these patients, the rate of peri- and postoperative intracranial bleeding events, postoperative thromboembolic events, hematologic findings, morbidity, and mortality were reviewed. A sub-analysis of factors influencing the bleeding risk of these patients and the bleeding rate depending on the preoperatively discontinuation time of NOACS, with a cutoff of 24 and 48 hours, was additionally completed.
Results: The rate of perioperative bleeding was 13.3% (n=4), leading to the death of two patients. The mean discontinuation time was significantly shorter in the patients experiencing a bleeding event compared to those without (1.5 days (range 0 to 3 days) vs. 11 days (range 0 to 120 days), respectively). The rate of perioperative thromboembolic events was 3.3% (n=1), and overall mortality rate was 13.3% (n=4).
Conclusions: The postoperative bleeding rate in patients undergoing cranial surgery treated with NOACS is 13.3%, while shorter preoperative discontinuation time seems to affect bleeding rates significantly. Further studies evaluating the management and postsurgical outcome of these patients are warranted.
Patient Care: Our research will improve patient care increasing awarness in the treatment of patients undergoing cranial surgery previously treated with NOAC.
Learning Objectives: By the conclusion of this session, neurosurgeons should be aware of the risks of intracranial bleeding in patients undergoing cranial surgery under NOAC and discuss the management of this kind of patients.