Antiplatelet Medication Reversal Strategies in Operative Intracranial Hemorrhage: A Survey of Practicing Neurosurgeons

Abstract

Background: Antiplatelet therapy is common and complicates operative management of acute intracranial hemorrhage. Few data exist to guide antiplatelet reversal strategies.

Methods: An online survey detailing antiplatelet reversal strategies in patients presenting with acute operative intracranial hemorrhage (subdural hematoma, epidural hematoma, and intracerebral hemorrhage) was distributed to board-certified neurosurgeons in North America.

Results: From 2782 functional e-mail addresses, there were 493 (17.7%) responses to question 1 and 429 (15.4%) completed surveys. Most respondents chose to perform no additional laboratory testing before surgical intervention, regardless of hemorrhage type. The most common antiplatelet reversal strategy in the presence of aspirin was platelet transfusion (subdural hematoma and intracerebral hemorrhage) or no intervention (epidural hematoma). The most common antiplatelet reversal strategy in the presence of an adenosine diphosphate antagonist or dual antiplatelet therapy was platelet transfusion or platelet transfusion with desmopressin acetate administration. There was a statistically significant difference in management strategy depending on the antiplatelet therapy (P < 0.001).

Conclusions: When patients on antiplatelet medication present with operative intracranial hemorrhage, the majority of neurosurgeons do not perform qualitative platelet testing. Antiplatelet reversal strategies are significantly influenced by the antiplatelet therapy with more aggressive reversal strategies employed in the presence of ADP antagonists.

Keywords: Antiplatelet; Antiplatelet reversal; Epidural hematoma; Intracerebral hemorrhage; Intracranial hemorrhage; Subdural hematoma.