Management of Anticoagulation Therapy in Focused Ultrasound Thalamotomy: A Series of 687 Patients.

Abstract

Magnetic resonance-guided focused ultrasound (MRgFUS) is an effective minimally invasive treatment of medication-refractory tremor. Risk of intracranial hemorrhage may prompt interruption of antiplatelet or anticoagulant medications. We present a large, single-center experience evaluating the safety of MRgFUS with continued antithrombotic therapies. We performed a retrospective review of 687 patients who underwent MRgFUS for tremor with postprocedure MRI. In February 2023, our institution changed its practice to no longer interrupt antithrombotic therapy before procedures. Hemorrhage rates, thromboembolic events, active medications, and sonication parameters were analyzed before and after this change in practice. There were zero intracranial hemorrhages across the entire cohort, including 179 patients with continued antithrombotic therapy at the time of procedure. There were no significant differences in maximum temperature (61.0°C vs 61.6; P = .135), maximum energy (17 354.6 J vs 17 723.7 J; P = .704), or number of sonications (5.8 vs 5.9; P = .461) between patients on antithrombotic therapy and patients not on therapy. There were no reported thromboembolic events associated with antithrombotic therapy interruption in the pre-2023 cohort. Our series of 179 uncomplicated MRgFUS cases performed while on continued antithrombotic therapy may suggest that continuing antithrombotic therapy during MRgFUS is reasonable in select patients.