Abstract: Background: For neurosurgery patients on antiplatelet or anticoagulation, there is a critical balance to be struck between the risks of bleeding and thromboembolic complications. A crucial distinction must be made, as the effects of even a small amount of over-bleeding are irreversible and fatal.
Key Findings: Aspirin can safely be continued for certain types of cranial or spinal procedures. P2Y12 inhibitors will need to be discontinued 5-10 days before operation. For Warfarin patients, the goal is an INR <1.4, and bridging is only recommended in extreme situations of thrombotic risk. All DOACs should be discontinued 48-72 hours before procedure, but emergency reversal is available if necessary (idarucizumab and andexanet alfa). Routine bridging anticoagulation should generally not be utilized.
Conclusion: Multidisciplinary, individualized decision making is necessary in each perioperative neurosurgical case; by accounting for the risks of bleeding from specific procedures versus individual thrombotic risks to a specific patient, one can provide adequate care. This review aims to offer a systematic evidence based approach to such a dilemma.
Keywords: anticoagulants; antiplatelet; neurosurgery; perioperative management; intracranial haemorrhage; bridging anticoagulation; DOAC reversal.
Title: Perioperative Management of Antiplatelet and Anticoagulant Therapy in Neurosurgical Patients: A Practical Review with Evidence-Based Flow Chart
Author: Dr. Rathikinda Srinivasulu, Dr Saurabh Patel
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 1, April 2026 - September 2026
Page No: 145-152
Research Publish Journals
Website: www.researchpublish.com
Published Date: 01-June-2026
