Normally, when any kind of surgery is performed, or even when you cut your finger, your blood clots. This is caused by a whole cascade of events beginning with blood platelets clumping together. This is a good thing because it stops blood loss and in the case of that cut finger, it provides the first step to forming a protective scab, ultimately enabling wound healing.

In some people, blood clots can actually be a problem. Clots form on the inside of blood vessel walls that can break loose and cause a heart attack or stroke. These patients are often given anti-clotting drugs or anti-platelet agents to prevent these events.

These patients usually have hardening of their arteries predisposing them to form these clots, and are likely to be the same kind of people that end up having endovascular surgery. This is a special kind of surgery that uses thin tubes and tiny instruments to operate inside a blood vessel. When someone has a blocked artery for example, endovascular surgeons can go in through the blood vessel and clear a path for blood to flow again. They can also put an expandable tube or intravascular stent in the vessel to keep it from getting blocked again. This kind of surgery is a good alternative to an open procedure because it is quicker to do, less invasive, and has a much faster recovery. Endovascular surgery repairs the blood vessel from the inside and requires only a needle puncture to gain access for treatment.

Because the work is done within the vessel, the devices are exposed to the bloodstream. Anti-clotting agents are used during the procedure to prevent problems, and patients respond to these agents differently. In patients that require stents to treat their disease, anti platelet drugs are required to limit clotting.

Dr. Sean Lavine from the Endovascular Center recently spoke to neurosurgeons on the use of anti-platelet agents in neurosurgery at the Congress of Neurosurgeons Meeting in New Orleans. He said that these kinds of drugs are “the mainstay for a myriad of medical conditions” but that doctors need to be well informed to use them. Some patients have a resistance to them or are taking another drug that can render the anti-platelet agent ineffective. These drugs include some acid reducers and those to lower cholesterol. It is also important to determine the correct dose for the patient with sophisticated testing. This can all be done by a taking a thorough history and physical of each patient, and performing these procedures at an experienced neuro-endovascular center. Dr. Lavine emphasized that it is critical to find the right balance between too much clotting and too much bleeding during open and endovascular surgery for the best outcome.