Objective: This is a retospective study about patients with chronic anticoagulation therapy who underwent DBS surgery in a time frame of 13 years.

Background: In the aging society, patients with movement disorders or pain syndromes who are candidates for deep brain stimulation (DBS) suffer from cardiovascular co-morbidities that require permanent anti-coagulation, such as atrial fibrillation, valvular or coronary diseases. Because of increased risk of intracranial hemorrhage, chronic anti-coagulation treatment usually has been considered a contraindication for DBS. Interruption of anti-coagulation therapy has to be balanced with the risk of ischemic complications or venous thromboembolism.

Method: This is a retrospective study on a cohort of 605 patients who underwent DBS within a 20-year period. Overall, 35 patients were identified who were under chronic anti-coagulation treatment. Patients were operated for Parkinson’s disease, dystonia, tremor and pain syndromes.

Results: Patients were under anti-coagulation with acetylsalicylic acid, clopidogrel, coumarin-derivates, rivaroxaban and apixaban. Operated disorders were Parkinsonysm (9), dystonia (7), tremor (18) and pain syndromes (1). Anti-coagulation treatment was paused during the perioperative phase. There were no cardiac or ischemic complications. The following perioperative adverse events were recorded: hematoma at the site of the implantable pulse generator (3 patients), stroke (1 patient) and intraventricular hemorrhage with hydrocephalus (1 patient). No hemorrhagic complications were noticed on long-term follow-up.

Conclusion: Deep brain stimulation in patients with chronic anti-coagulation treatment is possible. In the perioperative period,  precautions are necessary. Individual, patient-adapted approaches are recommended.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-patients-with-chronic-anti-coagulation-treatment-a-series-of-35-patients/