Clinical outcomes and hemorrhagic or thromboembolic risks in decompressive craniectomy for patients taking antiplatelet or anticoagulant therapy
Decompressive craniectomy (DC) is a critical surgical intervention for elevated intracranial pressure. However, the impact of preoperative antiplatelet or anticoagulant therapy on outcomes and complications remains unclear. A retrospective-prospective study was conducted on 145 patients undergoing DC between November 2021 and May 2023. Patients were categorized into two groups: those with (n = 48) and without (n = 97) preoperative antithrombotic therapy. Demographic data, comorbidities, antithrombotic therapy type and duration, clinical outcomes, and pre-operative risk factors (CHA2DS2-VASc and HAS-BLED scores) were analyzed. While there was a trend towards higher hemorrhagic complications in the antithrombotic therapy group (20.0% vs. 11.3%), this difference was not statistically significant. However, thromboembolic events, primarily stroke (27.7% vs. 9.3%) and acute myocardial infarction (10.6% vs. 0.0%), were significantly more frequent in the antithrombotic therapy group. Multivariate analysis revealed that ischemic stroke as a primary diagnosis, rather than antithrombotic therapy itself, was a significant predictor of thromboembolic complications (adjusted OR 3.49, 95%CI 1.47-8.28, p = 0.005). Pre-operative GCS was associated with improved outcomes (adjusted OR 0.81, 95%CI 0.67-0.97, p = 0.025). While antithrombotic therapy does not appear to increase the risk of hemorrhagic complications after DC, it is associated with a higher risk of thromboembolic events, especially in patients with ischemic stroke. Individualized assessment and tailored management of antithrombotic therapy are crucial to optimize outcomes in DC patients. Further studies are needed to refine strategies for bridging anticoagulation and managing antithrombotic therapy in this population, considering factors such as CHA2DS2-VASc and HAS-BLED scores, as well as patient-specific risk profiles.
Authors
- Luigi Maria Cavallo (ORCID: https://orcid.org/0000-0003-4576-5667)
- Luigino Tosatto (ORCID: https://orcid.org/0000-0002-8708-255X)
- Sara Lombardi (ORCID: https://orcid.org/0000-0003-1883-2369)
- Vittoria Rosetti (ORCID: https://orcid.org/0000-0002-8338-7372)
- Teresa Somma (ORCID: https://orcid.org/0000-0001-7864-1607)
- Grazia Menna (ORCID: https://orcid.org/0000-0003-2594-4967)
- Carmelo Lucio Sturiale (ORCID: https://orcid.org/0000-0002-4080-2492)
- Domenico Gerardo Iacopino (ORCID: https://orcid.org/0000-0003-1685-5209)
- Pasquale De Bonis (ORCID: https://orcid.org/0000-0002-9879-8940)
- Annamaria Auricchio (ORCID: https://orcid.org/0000-0002-4186-4476)
- Rosario Maugeri (ORCID: https://orcid.org/0000-0002-4954-9817)
- Fabio Raneri (ORCID: https://orcid.org/0000-0003-3522-7267)
- Oriela Rustemi (ORCID: https://orcid.org/0000-0002-4846-7641)
- Lara Brunasso (ORCID: https://orcid.org/0000-0003-3149-3314)
- Giorgio Lofrese (ORCID: https://orcid.org/0000-0001-5874-7340)
- G. Mantovani (ORCID: https://orcid.org/0000-0002-2164-2710)
- Francesco Signorelli (ORCID: https://orcid.org/0000-0002-5040-1916)
- Giampaolo Zambon
- Luca Ricciardi (ORCID: https://orcid.org/0000-0001-5110-8386)
- Michele Alessandro Cavallo
- Lapo Bonosi (ORCID: https://orcid.org/0000-0003-1487-6292)
- Maria Elena Flacco (ORCID: https://orcid.org/0000-0003-1404-4314)
- Nicola Montemurro (ORCID: https://orcid.org/0000-0002-3686-8907)
- Alba Scerrati (ORCID: https://orcid.org/0000-0002-8607-5323)
- Silvana Tumbiolo
- Lorenzo Sgarbanti
- Chiara Angelini
- Alessandro Adorno
- Giovanni Scanferla
Institutions
- Università Cattolica del Sacro Cuore (IT)
- University of Pisa (IT)
- University of Ferrara (IT)
- Agostino Gemelli University Polyclinic (IT)
- Ospedale “M. Bufalini” di Cesena (IT)
- Federico II University Hospital (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- University of Naples Federico II (IT)
- Sapienza University of Rome (IT)
Publication Details
- Journal
- Neurosurgical Review
- Published
- 2025-03-26
- DOI
- https://doi.org/10.1007/s10143-025-03491-4
- Citations
- 1
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 1.35
Funders
- Università Cattolica del Sacro Cuore