Novel Oral Anticoagulants in Patients Undergoing Cranial Surgery

BACKGROUND: The number of patients treated with novel oral anticoagulants (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 that might influence bleeding rates in these patients. METHODS: Out of 1353 consecutive patients undergoing cranial neurosurgical procedures, 30 (2.2%) received NOACs preoperatively. The rates of perioperative and postoperative intracranial bleeding events, rate of postoperative thromboembolic events, hematologic findings, morbidity, and mortality were reviewed. A subanalysis of factors influencing the bleeding risk of these patients and the bleeding rate depending on the preoperative discontinuation time of NOACS, with cutoff of 24 and 48 hours, was performed as well. RESULTS: The rate of perioperative bleeding was 13.3% (n = 4 of 30). Postoperative bleeding led to death in 2 patients. The median discontinuation time was significantly shorter in the patients experiencing a bleeding event compared to those without a bleeding event (1.5 days [range 0-3 days] vs. 11 days [range, 0-120 days]). The rate of perioperative thromboembolic events was 3.3% (n = 1), and overall mortality was 13.3% (n = 4). CONCLUSIONS: The postoperative bleeding rate in patients undergoing cranial surgery treated with NOACs was 13.3%. A shorter preoperative discontinuation time seems to have a significant effect on bleeding rate. Further studies evaluating the management and postsurgical outcomes of these patients are warranted.