World Neurosurg
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Review Meta Analysis
Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a clinical review.
Prehospital use of antiplatelet agents has been associated with an increased risk for intracranial hemorrhage (ICH) as well as a secondary increase in ICH volume after the initial hemorrhage. Strategies to reestablish platelet aggregation are used in clinical practice, but without any established guidelines or recommendations. This article serves to evaluate the literature regarding "reversal" of antiplatelet agents in neurosurgical populations. ⋯ The data assessing the relationship between outcome and prehospital antiplatelet agents in the setting of ICH is conflicting in both the trauma and the stroke literature. Only one retrospective review specifically addressed outcomes after attempted reversal with platelet transfusion. Further study is needed to determine whether platelet transfusion ameliorates hematoma enlargement and/or improves outcome in the setting of acute ICH.
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Surgical intervention is performed on the cervical spine in a heterogeneous number of pathologic conditions in a diverse patient population. Several authors have examined complication prevalence in cervical spine surgery using retrospective analysis. However, few prospective studies have directly examined perioperative complications. Most prospective studies in the spine literature have assessed only specific spinal implants in carefully selected surgical patients, and complication incidence in broader patient populations is limited. ⋯ The incidence of complications or adverse events is not definitely known for most spinal procedures because of the complexity of defining complications and obtaining accurate data. Therefore, to obtain a more accurate assessment of spinal procedures, a prospective algorithm was designed to collect and record complications during the acute perioperative period. Using this technique, a significantly higher complication rate was documented than had been previously reported for cervical spine operative interventions. In addition, use of a broad definition of perioperative complications likely increased the recorded incidence of perioperative adverse events and complications. Complications were more common in patients undergoing posterior and anteroposterior procedures.