Management of Aneurysmal Subarachnoid Hemorrhage Patients with Antiplatelet Use Before the Initial Hemorrhage: An International Survey

BACKGROUND: The case fatality in aneurysmal subarachnoid hemorrhage (aSAH) is 50% because of the initial hemorrhage or subsequent complications, such as aneurysmal rebleed or delayed cerebral ischemia. One factor that might influence the initial brain damage or subsequent complications is the use of antiplatelet medication before the initial hemorrhage. The goal of this survey was to assess the different management options of patients with aSAH with antiplatelet use before the initial hemorrhage. METHODS: An anonymous survey of 11 multiple choice questions about management of patients with aSAH with antiplatelet use before the initial hemorrhage was distributed to the international panel of attendees of the European Association of Neurosurgical Societies annual meeting in Venice, Italy, October 1-5, 2017. RESULTS: A total of 258 completed surveys (54%) were returned. In about 80% of the surveys, the departments of neurosurgery and neurology were responsible for acute management of patients with aSAH, whereas in 15% the intensive care unit was responsible. Department guidelines were present in 32%. In 65%, the responders always stopped the antiplatelet agent at admission, and in 4.3% thrombocytes are always transfused. When a guideline is present, the neurospecialists consider thrombocyte transfusion more often (83% vs. 65%, respectively; P = 0.02). CONCLUSIONS: Our survey among mainly European neurosurgeons shows that there is a significant variability in the management of patients with aSAH who have been using antiplatelets before the initial hemorrhage. These findings emphasize the importance of the development of evidence-based guidelines for management of patients with aSAH and antiplatelet use before the initial hemorrhage.