Is Antithrombotic Drug Interruption Necessary for Cranioplasty Following Decompressive Craniectomy for Cerebral Infarction Caused by Main-trunk Occlusion?

Abstract

Objective: We aimed to investigate whether it is necessary to interrupt antithrombotic drug administration at the time of cranioplasty after decompressive craniectomy for cerebral infarction.

Methods: We retrospectively examined 18 patients who underwent cranioplasty for cerebral infarction due to main trunk occlusion at our hospital between December 2008 and December 2016.

Results: The mean age of the patients was 68.8 years, with 14 men. Regarding the administration of antithrombotic drugs as maintenance therapy for cerebral infarction, 2 patients were given antiplatelet drugs, while 13 patients were given anticoagulant drugs. Owing to their general condition, 3 patients received no antithrombotic drugs. After cranioplasty, we interrupted the administration of antithrombotic drugs in 11 patients. These patients in addition to the 3 patients who were not given antithrombotic drugs were referred to as the interruption group. Heparin was given to 3 patients who we collectively referred to as the heparin group. Lastly, the administration group was composed of 4 patients who continued to take antithrombotic drugs. After cranioplasty, a total of 13 patients experienced either subcutaneous or epidural hematomas. Among them, 55% were in the interrupted group, while the remaining 45% of cases occurred in all of the patients in the heparin and administration groups. However, none of the hematomas needed to be removed.

Conclusion: Both antiplatelet drug administration and the replacement of anticoagulants with heparin can be considered prior to major surgery (Japanese Guidelines for the Management of Stroke 2015, grade C1). However, the worsening of symptoms due to interruptions in antithrombotic drug administration must also be considered. Nonetheless, hemostasis is easily achieved at the time of cranioplasty, and continued antithrombotic drug use is unlikely to result in bleeding requiring reoperation. While the prevailing guidelines regarding the interruption of medications should be adhered to, the respective risks of hemorrhagic and ischemic complications must be carefully considered.