gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Neurosurgical procedures and acetylsalicylic acid medication – is it safe to operate after careful preoperative patient selection and interdisciplinary consent?

Meeting Abstract

  • Julian Rathert - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt
  • Mohamut Alhallak - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt
  • Steffen Rosahl - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt
  • Andreas Steinbrecher - Klinik für Neurologie, HELIOS Klinikum Erfurt
  • Joachim Klisch - Institut für diagnostische und interventionelle Neuroradiologie, HELIOS Klinikum Erfurt
  • Harald Lapp - Klinik für Kardiologie, HELIOS Klinikum Erfurt
  • Rüdiger Gerlach - Klinik für Neurochirurgie, HELIOS Klinikum Erfurt

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.15.09

doi: 10.3205/13dgnc134, urn:nbn:de:0183-13dgnc1340

Published: May 21, 2013

© 2013 Rathert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.