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Antiplatelet medication7/27/2023 There is a considerable lack of consensus regarding management of antiplatelet therapy in neurosurgery, with critical impact on patient’s treatment. The present paper was designed by following each question posed in the survey by a brief discussion on literature data. This survey was conducted including 129 neurosurgery units in Italy. In this paper, we present the results of an Italian survey focused on the management neurosurgical patient under antiplatelet therapy and, for any item of the investigation, the relative advices coming from literature. Currently, the management of neurosurgical patients receiving this type of therapy continues to be a problem of special importance. 5.The use of antiplatelet medication is widespread as reducing risk of death, myocardial infarction, and occlusive stroke. 10.9% (monotherapy), NNT 34, for patients without stenosis 4.8% vs. primary endpoint at 30 days – for stenosis 8.1% vs.sub-analysis showed higher efficacy in patients with ipsilateral atherosclerotic involvement (stenosis ≥ 30%).effect present even in patients with NIHSS 4-5 (moderate stroke).the risk of the composite of stroke or death within 30 days was lower with ticagrelor–aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. severe bleeding: 28 (0.5%) vs 7 (0.1% aspirin group).a primary-outcome event (stroke or death) within 30 days: 303 (5.5% ASA+ticagrelor) vs.ASA alone (loading 300 mg, then 100 mg/d) ASA+ticagrelor (loading dose 180 mg, then 2x 90 mg daily) vs.TIA or mild stroke (NIHSS score ≤5) of noncardioembolic etiology, patients were not undergoing IVT or endovascular treatment.n=11,016 patients underwent randomization (5523 in the ticagrelor–aspirin group and 5493 in the aspirin group).perform a regular check of blood count during the first 3 months of treatment (first month each week, then every 14 days).adverse events: neutropenia (severe in approximately 1% of cases) and skin rash and diarrhea (severe in 2% of patients each) all reversible.there is a lower resistance incidence with ticlopidine compared to clopidogrel.The mean follow-up time was 2.3 years, NNT/year was 90. the TASS( Ticlopidine Aspirin Stroke Study) study published in 1993 showed a 2.6% reduction in absolute risk of fatal and non-fatal MI with ticlopidine compared to Anopyrin (11.2 vs.the CATS (Canadian American Ticlopidine Study) demonstrated a 6.5% absolute risk reduction in cerebral infarction over 2 years compared to placebo (10.1% vs.efficacy of ticlopidine has been demonstrated in the CATS and TASS trials.the onset of action of ticlopidine is gradual (within 6 h), reaching a maximum in approximately 6 days and persisting for 4-10 days after discontinuation.
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