Our Summary

This research paper is about the best time to start or restart blood-thinning medication after brain surgery. Starting this treatment too early might increase the risk of dangerous brain bleeding. However, there are situations where it’s necessary to use blood thinners right after surgery, despite the risk.

The researchers looked at the medical records of patients at one hospital who had blood-thinning treatment for blood clots in their veins within a week after brain surgery. They specifically looked for cases where brain bleeding led to death or required more surgery to remove the blood. They also checked for bleeding outside the brain, length of hospital stay, and if patients had to go back to the hospital within 90 days.

They ended up studying 18 patients. On average, the blood-thinning treatment started 5 days after surgery. One patient (about 5.6%) had brain bleeding 5 days after starting the treatment and needed more surgery to remove the blood. No patients had bleeding outside the brain. The average hospital stay was 13 days, and no patients had to go back to the hospital within 90 days. All patients survived the first 90 days after surgery.

The researchers concluded that starting blood-thinning treatment very early after brain surgery led to a 5.6% risk of brain bleeding. Therefore, while it can be done safely, it does come with a significant risk of brain bleeding that might require emergency surgery or cause permanent brain damage or death.

FAQs

  1. What is the risk of starting blood-thinning treatment early after brain surgery?
  2. What are the potential consequences of brain bleeding after starting blood-thinning treatment?
  3. How many patients in the study had to return to the hospital within 90 days of their surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about craniotomy is to follow their doctor’s recommendations closely, especially when it comes to starting or restarting blood-thinning medication after surgery. It is important to balance the risk of blood clots with the risk of brain bleeding, and to discuss any concerns or questions with their healthcare provider. It’s also important to monitor for any signs of complications and seek medical attention if any unusual symptoms occur.

Suitable For

Patients who are typically recommended for craniotomy include those with brain tumors, aneurysms, arteriovenous malformations, traumatic brain injuries, and other conditions that require surgical intervention within the brain. These patients may benefit from a craniotomy to remove tumors, repair blood vessel abnormalities, relieve pressure on the brain, or address other issues that cannot be treated with less invasive methods.

Timeline

Before craniotomy:

  1. Patient is diagnosed with a condition that requires brain surgery
  2. Patient undergoes pre-operative testing and consultations with the surgical team
  3. Patient is admitted to the hospital on the day of surgery
  4. Patient undergoes craniotomy procedure under general anesthesia
  5. Patient is monitored in the intensive care unit (ICU) post-surgery

After craniotomy:

  1. Patient is closely monitored for any signs of complications, such as bleeding or infection
  2. Patient may be started on blood-thinning medication to prevent blood clots
  3. Patient is gradually weaned off of pain medication and other interventions
  4. Patient begins physical therapy and rehabilitation to regain strength and function
  5. Patient is discharged from the hospital and continues outpatient follow-up care
  6. Patient may experience ongoing symptoms or side effects related to the surgery, such as headaches or changes in cognitive function.

What to Ask Your Doctor

  1. What are the potential risks and benefits of starting blood-thinning medication after my craniotomy surgery?
  2. How soon after my surgery would you recommend starting blood-thinning medication?
  3. Are there any specific factors about my medical history or the type of surgery I had that would impact the decision to start blood thinners?
  4. What signs or symptoms should I watch out for that may indicate a problem with the blood-thinning medication?
  5. How closely will my blood levels need to be monitored while on blood thinners after surgery?
  6. Are there any alternative treatments or strategies that could be considered in place of blood thinners?
  7. What is the plan for managing any potential complications or side effects of blood-thinning medication after surgery?
  8. How long will I need to continue taking blood thinners after surgery?
  9. What are the chances of experiencing brain bleeding or other complications if blood thinners are started early after surgery?
  10. Are there any specific lifestyle changes or precautions I should take while on blood-thinning medication after surgery?

Reference

Authors: Riviere-Cazaux C, Naylor RM, Van Gompel JJ. Journal: J Clin Neurosci. 2022 Jun;100:46-51. doi: 10.1016/j.jocn.2022.03.042. Epub 2022 Apr 6. PMID: 35397255