Surgery for carpal tunnel syndrome under antiplatelet therapy

Abstract Objective Antiplatelet therapy is often instituted after cardiovascular or neurological ischemic events. In general, discontinuation of the antiplatelet medication for several days is warranted previous to surgery. However, discontinuation can lead to ischemic events. For some forms of surgery, the risks of an ischemic event, and especially, its consequences do not outweigh the benefit of discontinuation of the antiplatelet therapy. Retrospective analysis was done of a cohort of patients treated for carpal tunnel syndrome with special emphasis on postoperative hemorrhage in combination with antiplatelet medication. Methods Retrospective analysis of cohort consisting of 362 consecutive patients treated for carpal tunnel syndrome in the Neurosurgical Centre, Nijmegen was done. Results In 362 patients 423 operations on carpal tunnel release were done. Thirty-one patients were on antiplatelet therapy, of which 6 did not discontinue the medication before surgery. The remaining patients stopped at least seven days before surgery. A postoperative hemorrhage did not occur in any of the 423 operations. Conclusion There seems no reasonable evidence that discontinuation of aspirin for carpal tunnel syndrome is justified. Bleeding complications are considered rare, moreover the impact of an ischemic cardiovascular or a cerebral event would be far more severe than that of postoperative hemorrhage in the wrist.