• 作者：Ph. Guerci ; G. Audibert ; ^{g.audibert@chu-nancy.fr} ; P.-M. Mertes
• 关键词：Neurochirurgie r&eacute ; gl&eacute ; e ; Antivitamine K ; H&eacute ; parine ; Anti-agr&eacute ; gant plaquettaire ; P&eacute ; riode p&eacute ; ri-op&eacute ; ratoire
• 刊名：Neurochirurgie
• 出版年：2009
• 期刊代码：pca376_00283770
• 类别：neu
• 出版时间：December, 2009
• 卷：55
• 期：6_supp_S1
• 页码：H17-H22
• 文件大小：412 K

Perioperative management of chronic treatments with anticoagulants or antiplatelet drugs is particularly critical before scheduled neurosurgery. A double risk must be assessed: both the hemorrhagic risk related to ongoing treatments and the thrombotic risk during treatment withdrawal related to the underlying disease.

Neurosurgery is usually considered a procedure with high hemorrhagic risk. The assessment of the thrombotic risk related to the underlying disease requires a multidisciplinary meeting associating the neurosurgeon, the cardiologist, and the anesthetist, who decide how the treatment should be managed perioperatively, particularly the question of whether a drug substitution is necessary. The decision is recorded in the patient's file.

This review will cover the problems with preoperative treatment with vitamin K antagonists, heparin (fractionated or unfractionated), and antiplatelet agents. For each case, the withdrawal procedures and the possible shift to another treatment are discussed. For patients with coronary stents, an algorithm (including the possibility of postponing surgery) is proposed.