尽管这些患者发生血栓栓塞并发症的风险较高，但在择期颅脑手术之前停用抗血栓药物 (AT) 是常见做法。本研究的目的是调查择期颅脑手术中继续或超早期 AT 恢复的新围手术期管理方案的风险和益处。本研究对前瞻性收集的接受择期颅脑手术 (AT组）和没有（对照组）AT。对于轴外或分流手术，围手术期继续使用乙酰水杨酸（ASA）。对于轴内病变，术前 2 天停用 ASA，并在术后第 3 天恢复。所有其他 AT 根据其药代动力学停用，并在术后影像无异常后于术后第 3 天恢复。此外，作者对在实施新的 AT 管理方案之前接受手术的 AT 患者（历史 AT 组）进行了回顾性分析。主要和次要结局是术后 3 个月内出血和血栓栓塞并发症的发生率。分析了 312 名患者的结果（AT 组 83 名 [27%]，对照组 106 名 [34%]，对照组 123 名 [39%] ] 在历史AT组中）。对于所有 3 个患者组，最常见的手术类型是轴内肿瘤开颅手术（AT 组 14 例 [17%]，对照组 28 例 [26%]，历史 AT 组 60 例 [49%]） 。最常用的 AT 是 ASA（AT 组中 38 例 [46%]，历史 AT 组中 78 例 [63%]），其次是非维生素 K 口服抗凝剂（AT 组中 32 例 [39%]，历史 AT 组中 18 例）。 [15%]在历史AT组中）。 AT 组的总围手术期停药时间明显短于既往 AT 组（中位数为 4 天与 16 天；p < 0.001）。 AT 组出血并发症发生率为 4% (95% CI 1-10) (n = 3/83)，对照组为 6% (95% CI 2-12) (n = 6/106)，历史 AT 组中的这一比例为 7% (95% CI 3-13) (n = 9/123) (p = 0.5)。 AT 组血栓栓塞并发症发生率为 5% (95% CI 1-12) (n = 4/82)，对照组为 8% (95% CI 3-15) (n = 8/104)，历史 AT 组中的这一比例为 7% (95% CI 3-13) (n = 8/120) (p = 0.7)。在选择性颅脑手术中继续或超早期恢复 AT 的围手术期管理方案似乎并不适用增加出血风险。此外，它似乎有可能保护患者免受血栓栓塞并发症的影响。

Discontinuation of antithrombotics (AT) prior to elective cranial procedures is common practice, despite the higher risk of thromboembolic complications in these patients. The aim of this study was to investigate the risks and benefits of a new perioperative management protocol of continuation or ultra-early AT resumption in elective cranial procedures.This study was an analysis of a prospectively collected cohort of patients undergoing elective cranial surgery with (AT group) and without (control group) AT. For extraaxial or shunt surgeries, acetylsalicylic acid (ASA) was continued perioperatively. For intraaxial pathologies, ASA was discontinued 2 days before surgery and resumed on postoperative day 3. All other AT were discontinued according to their pharmacokinetics, and resumed on postoperative day 3 after unremarkable postoperative imaging. Additionally, the authors performed a retrospective analysis of patients with AT who underwent surgery before implementation of this new AT management protocol (historical AT group). Primary and secondary outcomes were the incidence of hemorrhagic and thromboembolic complications within 3 months after surgery.Outcomes of 312 patients were analyzed (83 [27%] in the AT group, 106 [34%] in the control group, and 123 [39%] in the historical AT group). For all 3 patient groups, the most common type of surgery was craniotomy for intraaxial tumors (14 [17%] in the AT group, 28 [26%] in the control group, and 60 [49%] in the historical AT group). The most commonly used AT were ASA (38 [46%] in the AT group and 78 [63%] in the historical AT group), followed by non-vitamin K oral anticoagulants (32 [39%] in the AT group and 18 [15%] in the historical AT group). The total perioperative discontinuation time in the AT group was significantly shorter than in the historical AT group (median of 4 vs 16 days; p < 0.001). The rate of hemorrhagic complications was 4% (95% CI 1-10) (n = 3/83) in the AT group, 6% (95% CI 2-12) (n = 6/106) in the control group, and 7% (95% CI 3-13) (n = 9/123) in the historical AT group (p = 0.5). The rate of thromboembolic complications was 5% (95% CI 1-12) (n = 4/82) in the AT group, 8% (95% CI 3-15) (n = 8/104) in the control group, and 7% (95% CI 3-13) (n = 8/120) in the historical AT group (p = 0.7).The presented perioperative management protocol of continuation or ultra-early resumption of AT in elective cranial procedures does not seem to increase the hemorrhagic risk. Moreover, it appears to potentially protect patients from thromboembolic complications.