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Survey of neurosurgical management of central nervous system hemorrhage in patients receiving anticoagulation therapy: current practice is highly variable and may be suboptimal.
MedLine Citation:
PMID:  21986428     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Patients with central nervous system (CNS) hemorrhage who receive anticoagulation (AC) therapy are at high risk for progressive or recurrent hemorrhagic and thromboembolic (TE) events. The authors conducted a survey at the 2010 American Association of Neurological Surgeons (AANS) annual meeting to determine how these patients are currently being managed by neurosurgeons.
METHODS: During plenary session III at the 2010 AANS annual meeting, the audience was presented with an illustrative case and surveyed with an audience response system. The number choosing each response as well as data regarding the level of training of meeting registrants were provided to the authors by the AANS.
RESULTS: Approximately 10% of all meeting registrants responded to the questions, 65% of whom were consultant neurosurgeons. The responses showed that 47.7% of respondents face dilemmas regarding AC restart time and intensity at least once per week. The most commonly selected AC restart time was 1 month after the index hemorrhage (43.5%); 8.0% indicated they would not restart AC. In making management decisions in these patients, 59.4% of respondents indicated that they relied predominantly on their own intuition or past experience.
CONCLUSIONS: This study is the first to describe how patients with CNS hemorrhage who receive AC therapy are currently being managed by clinicians. An apparent neurosurgical preference to avoid hemorrhagic complications is at odds with a suggested early risk for TE. These data suggest that the neurosurgical management of patients with CNS hemorrhage who receive AC therapy is an area that could benefit from consensus-based practice guidelines and an organized effort at knowledge translation and mobilization.
Authors:
Gregory W J Hawryluk; Julio C Furlan; James W Austin; Michael G Fehlings
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World neurosurgery     Volume:  76     ISSN:  1878-8750     ISO Abbreviation:  World Neurosurg     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101528275     Medline TA:  World Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  299-303     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
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