Safety of Restarting Antiplatelet or Anticoagulant Medications in the Perioperative Period of Mr-guided Focused Ultrasound (MRgFUS) Procedures

Introduction: MR guided focused ultrasound (MRgFUS) thalamotomy is a noninvasive lesioning technique used in the treatment of Essential Tremor (ET) and tremor dominant Parkinson’s Disease (tPD). The side effects profiles are mild, transient, and there have been no reported incidence on intracranial hemorrhage. However, many of the landmark trials for MRgFUS excluded patients taking any form of anticoagulation or antiplatelet (AC/AP) medication. This study aimed to evaluate the safety restarting AC/AP medications on post-operative day one after MRgFUS thalamotomy.

Methods: This was a single-center retrospective cohort study of 50 consecutively treated patients who underwent MR guided focused ultrasound (MRgFUS) thalamotomy to treat medically refractory tremor from April 2023 to June of 2024 (n=50). Patient demographic data and medication regiment was recorded at the pre-operative visit. Patients stopped any anticoagulation or antiplatelet medication at least five days prior to MRgFUS procedure and all of them restarted their medication regiment on post-operative day one. The primary outcome was incidence of asymptomatic (evidenced on post procedure imaging) or symptomatic hemorrhagic complications in the perioperative period. Post procedural MRI imaging was performed immediately following ablation and at three months.

Results: The cohort had a mean age of 76.46 (sd = 6.36) and were predominantly males (M:F, 41:9). 50 patients underwent VIM targeted MRgFUS; 47 patients for ET and 3 for tPD. 30 patients were on one or more form of anticoagulation (AC) or antiplatelet agents (AP) medications at their preoperative visit – 18 ASA, 4 apixaban, 1 rivaroxaban, 2 ASA/apixaban, 1 apixaban/clopidogrel, 2 ASA/clopidogrel, 1 rivaroxaban/clopidogrel, 1 ASA/ticagrelor. There was no incidence of hemorrhagic complication within the perioperative period for any patients who restarted their AC/AP regimen on postoperative day one.

Conclusion : Our results suggest the relative safety of resuming blood thinner agents in the early postprocedural period after MRgFUS thalamotomy. These findings maybe be considered in treatment decision making particularly for those high-risk patients for whom prolonged discontinuation of blood thinners poses significant risks.