Full length articleImpact of antithrombotic treatment on clinical outcomes after craniotomy for unruptured intracranial aneurysm

•Outcomes after craniotomy does not depend on perioperative antithrombotic treatment.•Intracranial hemorrhage correlates with perioperative antithrombotic treatment.•Morbidity associates with posterior location of the aneurysm and surgical procedure.

ObjectivePatients receiving antithrombotic treatment occasionally undergo craniotomy. We aimed to explore the impact of perioperative use of antithrombotic agents on the occurrence of surgical complications and clinical outcomes in patients with unruptured intracranial aneurysm (UIA).Patients and methodsWe retrospectively analyzed 401 consecutive patients who had undergone craniotomy for UIA at our institution between January 2006 and December 2016. Patients were divided into two groups: those who received oral antiplatelet and/or anticoagulant agents during the perioperative period (antithrombotic treatment group, n = 45); and those who did not (no antithrombotic treatment group, n = 356). In the antithrombotic treatment group, 40 patients received antiplatelet alone, 2 received anticoagulant alone, and 3 received antiplatelet plus anticoagulant.ResultsThe two groups showed no significant differences in mortality, morbidity, or occurrence of symptomatic brain infarction, but intracranial hemorrhage was more frequent in the antithrombotic treatment group than in the no antithrombotic treatment group (p = 0.0187). Multivariate analysis revealed posterior location of the aneurysm (odds ratio (OR), 8.10; 95% confidence interval (CI), 2.77-23.68; p = 0.0001) and surgical procedure (OR, 5.48; 95%CI, 1.68-17.86; p = 0.0048) as significantly correlated with severe morbidity, and intracranial hemorrhage as correlated significantly with antithrombotic treatment (OR, 3.83; 95%CI, 1.36-10.76; p = 0.0110).ConclusionsThis study provides important information about the occurrence of intracranial hemorrhage and clinical outcomes in patients undergoing antithrombotic treatment during the perioperative period of craniotomy for UIA.