Table 1 The survey
Question 1: In the last year, indicate the approximate percentage of patients admitted in your department with “acute” neurosurgical indication (e.g. acute/chronic epidural-subdural hematomas, ICH, SAH, Traumatic Subarachnoid Hemorrhage), in anticoagulant therapy. | |
|---|---|
Possible answers | |
o less than 10% | |
o between 10 and 25% | |
o between 25 and 50% | |
o between 50 and 75% | |
o more than 75%. | |
Question 2: In the clinical scenario of the above mentioned acute neurosurgical pathologies, in which conditions do you apply a “forced” emergency reversal of anticoagulant agents? | |
Possible answers: | |
o Only if a surgical treatment is plenned | |
o Also If a conservative treatment is planned | |
Question 3: In the eventuality of the clinical scenario of the above mentioned “acute neurosurgical pathologies”, how do you reverse VKA patients? For every option listened, please choose among routinely, frequently, rarely and never | |
Vitamin K | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Vitamin K plus Fresh Frozen Plasma | |
routinely | |
o frequently | |
o rarely | |
o never | |
Vitamin K plus Prothrombin Complex Concentrate | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Prothrombin Complex Concentrate alone | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Recombinant Activated Factor VII | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Recombinant Activated Factor VII plus Vitamin K | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Question 4: In the eventuality of the clinical scenario of the above mentioned (“acute neurosurgical pathologies”), how do you reverse DOAC patients? For every option listened, please choose among routinely, frequently, rarely and never | |
Vitamin K | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Vitamin K plus Fresh Frozen Plasma | |
routinely | |
o frequently | |
o rarely | |
o never | |
Vitamin K plus Prothrombin Complex Concentrate | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Prothrombin Complex Concentrate alone | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Activated Prothrombin Complex Concentrate | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Recombinant Activated Factor VII | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Recombinant Activated Factor VII plus Vitamin K | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Specific Reversal Agent (if available) | |
o routinely | |
o frequently | |
o rarely | |
o never | |
Question 5: How do you assess anticoagulant effects in patients on DOACSs with acute neurosurgical pathologies? (multiple answers possible) | |
o Drug’s half-life | |
o Time from the last intake of the drug | |
o PT/aPTT | |
o INR | |
o Specific assay | |
Question 6: What is the optimal timing for initiating venous thromboembolism chemoprophylaxis after intracranial bleeding or after elective surgery? | |
o less than 2 days | |
o between 2 and 4 days | |
o between 4 and 7 days | |
o more than 7 days | |
Question 7: In your opinion, what is the optimal timing for anti-thrombotic therapy resumption in patients at high thrombotic risk (e.g. valvular atrial fibrillation, ventricular devices)? | |
o less than 5 days | |
o between 5 and 10 days | |
o more than 10 days | |
Question 8: In your opinion, what is the optimal timing for anti-thrombotic therapy resumption in patients at moderate thrombotic risk (e.g. non-valvular atrial fibrillation)? | |
o less than 5 days | |
o between 5 and 10 days | |
o more than 10 days | |
Question 9: In your opinion, what is the optimal timing for anti-thrombotic therapy resumption in patients atlow-thrombotic risk (e.g. previous history of deep venous thrombosis)? | |
o less than 5 days | |
o between 5 and 10 days | |
o more than 10 days | |
Question 10: Do you usually ask for a cardiological evaluation for the perioperative management of anticoagulated patients? | |
o Yes | |
o No |