Management of Antithrombotic Drugs in Neurosurgical Practice

Abstract

Stroke is one of the most important diseases that must be prevented in Japan, where there has been a robust increase in the number of aged people, and where the opportunities for initiating stroke patients on antithrombotic therapy are also increasing. Antithrombotic therapy consists of thrombolytic therapy, antiplatelet therapy, and anticoagulant therapy. In order to reduce the risk of intravenous thrombolysis with rt-PA, it is important to start the treatment promptly in compliance with the recommended protocols. Dual antiplatelet therapy should be avoided in patients with microbleeds on MRI-T2* images. In patients with a non-valvar atrial fibrillation, non-vitamin K antagonist oral anticoagulant therapy is advisable. It is important to tailor antithrombotic therapy to individual needs, taking into account the clinical background of each patient and also the ethnic characteristics of the Japanese people. In the event of serious complications such as intracranial hemorrhage or gastrointestinal bleeding, it is important to determine whether to continue the antithrombotic therapy or not. In order to assess the risks and benefits of the treatment objectively, clinically available indicators and scoring systems need to be developed.