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Management of Bleeding Disorders in the Neurosurgical Patient 

Management of Bleeding Disorders in the Neurosurgical Patient
Chapter:
Management of Bleeding Disorders in the Neurosurgical Patient
Author(s):

Vedavyas Gannamani

and Sanaa Rizk

DOI:
10.1093/med/9780190913779.003.0007
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date: 09 April 2020

Postoperative patients are carefully monitored for bleeding due to its potential to result in dire situations, including death. Patients undergoing neurological surgeries are at heightened risk of morbidity and mortality from postsurgical bleeding due to compact neuroanatomical spaces and flow-sensitive organs. Hospitalists are regularly involved in the management of neurosurgery patients for preoperative risk assessment and medical co-management and must therefore have a good understanding of the predisposing factors that identify at-risk patients to avoid or minimize postoperative bleeding. The major factors to consider while assessing the risk of postoperative bleeding can be broadly divided into surgical and patient-related (nonsurgical). Patients on antiplatelet or anticoagulant agents pose a special management challenge in the perioperative period because interruption of these medications can increase the risk of cardiovascular or thromboembolic events postoperatively. This chapter outlines the general principles of perioperative management of bleeding disorders and postsurgical bleeding in neurosurgery patients admitted for elective or emergent surgeries. Management of patients primarily admitted for intracranial hemorrhage, spinal cord hematoma, or trauma will be discussed separately. This chapter also discusses interventions and therapies to reduce chances of perioperative bleeding in those with patient-related risk factors and reviews current practice guidelines on perioperative adjustment of anticoagulant or antiplatelet agents in patients undergoing neurosurgery.

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