Perioperative interruption of antiplatelet medications for elective extradural non-instrumented spine surgery: it is really necessary?

It is more and more frequent that patients taking antiplatelets for cardiac, cerebral or peripheral vascular diseases are referred for spine surgery. Even though there are not guidelines, the most common attitude in Italy is suggesting antiplatelets withdrawal at least 5-7 days before surgery. This is mainly due to fear of legal controversies, rather than evidence-based data on higher hemorrhagic risks. On the other hand, several studies questioned this attitude reporting perioperative increased risks of cardiovascular syndromes in patients discontinuing antiplatelets, due to increased endogenous catecholamines, platelet adhesiveness and decreased fibrinolysis.1