Article
Neurosurgical procedures and acetylsalicylic acid medication – is it safe to operate after careful preoperative patient selection and interdisciplinary consent?
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Published: | May 21, 2013 |
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Objective: In the past the majority of Neurosurgeons rejected to perform neurosurgical procedures on patients while on aspirin. However, there are increasing data from cardiology and neurology which implicate, that cessation of perioperative aspirin therapy in patients with secondary prophylaxis carries a very high risk for perioperative cardiac complications and/ or stroke. However, such risk benefit stratification has not been done for neurosurgical patients so far. Therefore we developed an algorithm for patients, who have to undergo neurosurgical procedures while on perioperative aspirin medication and report the preliminary results of a small patients series operated while on aspirin.
Method: From January 2012 to November 2012 62 neurosurgical procedures (5%) were performed in 56 patients with perioperative aspirin medication (100mg). Procedures were grouped as spinal extradural (16), spinal intradural (3), cranial vascular (4), cranial tumor (4), cranial others (23) and vp-shunting or external drainage (12). Al patients had thorough preoperative interdisciplinary risk evaluation according to their co-morbidity. Data of all patients were prospectively entered into a data base and perioperative bleeding complications (defined as requiring surgical revison) were analyzed. All patients underwent postoperative DVT- prophylaxis using 40mg enoxaparin up from day one after surgery.
Results: No relevant bleeding complication was encountered and no perioperative arterial cardiovascular event occurred in this series. In 1 patient undergoing an elective microsurgical clip-occlusion of a internal carotid artery aneurysm diffuse bleeding occurred during surgery, but was managed with desmopressin administration without the need for further hemostatic replacement therapy.
Conclusions: Although the number of patients is small, no major bleeding complications occurred in this series of patients undergoing (major) neurosurgical procedures while on aspirin after a thorough risk analysis. Further prospective data collection is necessary to confirm the safety of this pharmacological perioperative intervention.