Abstract: Background: For neurosurgery patients on antiplatelet or anticoagulation, there is a critical balance to be struck between the risks of bleeding and thromboembolic complications. A crucial distinction must be made, as the effects of even a small amount of over-bleeding are irreversible and fatal. Key Findings: Aspirin can safely be continued for certain types of cranial or spinal procedures. P2Y12 inhibitors will need to be discontinued 5-10 days before operation. For Warfarin patients, the goal is an INR <1.4, and bridging is only recommended in extreme situations of thrombotic risk. All DOACs should be discontinued 48-72 hours before procedure, but emergency reversal is available if necessary (idarucizumab and andexanet alfa). Routine bridging anticoagulation should generally not be utilized. Conclusion: Multidisciplinary, individualized decision making is necessary in each perioperative neurosurgical case; by accounting for the risks of bleeding from specific procedures versus individual thrombotic risks to a specific patient, one can provide adequate care. This review aims to offer a systematic evidence based approach to such a dilemma. Keywords: anticoagulants; antiplatelet; neurosurgery; perioperative management; intracranial haemorrhage; bridging anticoagulation; DOAC reversal. Title: Perioperative Management of Antiplatelet and Anticoagulant Therapy in Neurosurgical Patients: A Practical Review with Evidence-Based Flow Chart Author: Dr. Rathikinda Srinivasulu, Dr Saurabh Patel International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 14, Issue 1, April 2026 - September 2026 Page No: 145-152 Research Publish Journals Website: www.researchpublish.com Published Date: 01-June-2026 DOI: https://doi.org/10.5281/zenodo.20486045 Paper Download Link (Source) https://www.researchpublish.com/papers/perioperative-management-of-antiplatelet-and-anticoagulant-therapy-in-neurosurgical-patients-a-practical-review-with-evidence-based-flow-chart