Perioperative Management of Anticoagulant and Antiplatelet Therapy in Elective Neurosurgery Patients: A Narrative Review.

Antiplatelet and anticoagulant medications are widely prescribed to the general population for therapeutic and prophylactic purposes in a wide range of diseases, mainly of cardiovascular interest, spanning from acute events such as acute coronary syndromes (ACS), strokes, and thromboembolic disorders to chronic conditions like atrial fibrillation (AF) and peripheral vascular diseases. The management of such therapies is expected to escalate over time due to the aging population, which has a growing need for these medications, and the rising demand for surgical procedures. The management of anticoagulants and antiplatelets still represents a tough challenge for clinicians in elective neurosurgical procedures, where the balance between preventing thromboembolic events and an increased bleeding risk plays a crucial role in all phases of the perioperative setting. Managing antiplatelet and anticoagulant drugs in elective neurosurgery is complex and requires a tailored and multidisciplinary approach. Careful assessment of patient factors, surgery type, and potential risks and benefits is essential. POC testing can be valuable in optimizing therapy management and bleeding risk assessment. This narrative review for clinicians aims to provide an updated overview of the management of these drugs in the perioperative setting of elective neurosurgical procedures. We explored coagulation abnormalities commonly found in neurosurgical patients, the pharmacological profile of each class of drugs, the appropriate management according to the type of procedure (brain or spinal), and the available diagnostic tests, focusing on the application of point-of-care (POC) coagulation testing.