PERIOPERATIVE MANAGEMENT IN CRANIOTOMY PATIENTS ON ANTIPLATELET AND ANTICOAGULANT THERAPY: A CROSS-SECTIONAL STUDY AT A TERTIARY CARE HOSPITAL IN PAKISTAN

BACKGROUND: The perioperative period, comprises the time before and after surgery, with a range from one week before surgery to four weeks following it. The five weeks are marked by occurrences during which most thrombotic and bleeding complications associated with perioperative antithrombotic management take place. Management of these risks presents a clinical challenge, particularly in neurosurgical procedures such as craniotomy due to high hemorrhagic potential of the procedure. OBJECTIVE: To evaluate perioperative management strategies and associated complications in patients undergoing craniotomy while receiving antiplatelet and anticoagulant therapy. METHODOLOGY: This is a cross-sectional study, conducted on 300 craniotomy patients over two years from 1st February 2022 till 1st January 2024 at the Irfan General Hospital, Peshawar. Patients aged 20 years and older receiving antiplatelet (aspirin, clopidogrel) or anticoagulant therapy (VKA, DOACs, and LMWH) were included. Data collection focused on patients’ demographics, perioperative management strategies, and post-op complications. SPSS software was used to analyze the data. RESULTS: Among 300 patients, 195 (65%) received AP therapy, while 105(35%) were on AC therapy. Aspirin (36.7%) and clopidogrel (28.3%) were commonly used AP drugs. Whereas, VKA (18.3%) was primarily an AC drug. Perioperative management strategies varied, with 35% of patients temporarily discontinuing anticoagulants, 25% receiving bridging therapy with heparin, and 10% switching to LMWH. In AP therapy, minimal bleeding was observed in most patients (96, 49.2%), while in AC therapy, moderate bleeding was noticed at a greater rate of 38, 35.2%) indicating a significant difference in bleeding severity (p < 0.01). CONCLUSION: This study highlights the prevalence of antithrombotic therapy among craniotomy patients and enhances the importance of individualized perioperative management to minimize complications. Temporary discontinuation and bridging strategies are some of the perioperative techniques commonly used. KEYWORDS: Antiplatelet, Anticoagulants, Craniotomy, Perioperative.