Volume 3, Issue 1 (1-2025)
Neuroscience Updates 2025, 3(1): 36-50 |
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Mozafari P, Basmajian G, Rahmath D, Kalsahakian A, Hamza Sayed M, Bagheri M H. Redefining Anticoagulation in Neurosurgical Patients with Atrial Fibrillation: A Narrative Review of Risk Mitigation and Personalized Neuroprotection. Neuroscience Updates 2025; 3 (1) :36-50
URL: http://neuroupdates.de/article-1-125-en.html
URL: http://neuroupdates.de/article-1-125-en.html
Parvin Mozafari *1 
, Garin Basmajian2 , Daniya Rahmath2 , Alvina Kalsahakian2 , Mohammed Hamza Sayed2 , Mohammad Hassan Bagheri3
, Garin Basmajian2 , Daniya Rahmath2 , Alvina Kalsahakian2 , Mohammed Hamza Sayed2 , Mohammad Hassan Bagheri3
1- Faculty of Medicine, University of Georgia, Tbilisi, Georgia
2- Yerevan State Medical University, Yerevan, Armenia
3- Tehran University of Medical Sciences, Tehran, Iran
2- Yerevan State Medical University, Yerevan, Armenia
3- Tehran University of Medical Sciences, Tehran, Iran
Abstract: (18 Views)
Intracerebral hemorrhage (ICH) occurs as a disastrous complication in any surgical patient who is undergoing neurosurgery and especially in those who have atrial fibrillation and are under anticoagulation treatment. There exists a dilemma of risk versus bleeding in the clinical care of such patients. The proposed narrative review will help to establish optimal practices in the management of anticoagulants and neuroprotection in atrial fibrillation patients undergoing neurosurgery. The extensive literature search was carried out in PubMed, and the studies that reported the results of different anticoagulation treatments and their effects on the outcomes of surgery were selected. The data obtained were thematically synthesized to provide the patterns of clinical and pharmacological trends. The discussion identifies the neurological issues experienced by such patients with the focus on the maintenance of neuronal survival and cerebral homeostasis. A proposal of a so-called neuro-safe window to restart anticoagulation is discussed, taking into account the nature of anticoagulants used, cerebral autoregulation, and patient peculiarities. The review recommends an individual approach to anticoagulation, with neuro-specific parameters and methods of monitoring being added to improve neurological outcome. In addition, the opportunities of neuroprotective measures, e.g. facilitating microvascular blood flow and autoregulation, are addressed. To sum up, the anticoagulants management and reduction of the neurological events in the patients undergoing neurosurgery with atrial fibrillation require personalized risk models and future trials.
Keywords: Neurosurgery, Intracranial hemorrhage, Atrial fibrillation, Anticoagulant therapy, Ischemic stroke
Type of Study: Review Article |
Subject:
Neurodegenerative Disease
Received: 2025/05/25 | Accepted: 2025/07/10 | Published: 2025/07/20
Received: 2025/05/25 | Accepted: 2025/07/10 | Published: 2025/07/20
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