Anticoagulation considerations in neurosurgery

Most of these issues have not been studied in a rigorous, prospective fashion. Yet, these questions frequently arise. The following is to be considered a framework of guidelines and is not to be construed as a standard of care.

Choice of oral anticoagulant: compared to vitamin K antagonists (VKAs) (e.g. warfarin), the novel oral anticoagulants (NOACs) dabigatran, rivaroxaban & edoxaban are at least as effective in preventing ischemic stroke and systemic embolization in patient with atrial fibrillation. And compared to warfarin, NOACs reduce ICH by about 50%, have a more rapid onset of action, a shorter half-life, more predictable pharmacokinetics, fewer drug-drug interactions, and do not require routine monitoring.