Article
Evaluation of continued application of acetylsalicylic acid (ASA, Aspirin) in relation to postoperative haemorrhage in patients undergoing aneurysm clipping
Bewertung der fortgesetzten Anwendung von Acetylsalicylsäure (ASS, Aspirin) im Zusammenhang mit postoperativen Blutungen bei Patienten, die sich einem Aneurysma-Clipping unterziehen
Search Medline for
Authors
Published: | June 4, 2021 |
---|
Outline
Text
Objective: There is increasing use of acetylsalicylic acid (ASA) among patients with heart disease or stroke, and additionally in primary prevention among aging populations. Does continued application of ASA lead to an increased risk for postoperative hemorrhage in patient undergoing aneurysm clipping. However, studies in the neurosurgical field dealing specifically with postoperative hemorrhagic complications due to continuous ASA application are very rare. In the present study, we have evaluated the incidence and risk of continued ASA use as it relates to postoperative hemorrhage in patients undergoing aneurysm clipping.
Methods: We have retrospectively analyzed 200 consecutive clipping procedures performed between 2008 and 2018. Two different statistical models utilizing Fisher’s exact test have been applied. The first model consists of two groups: (1) No ASA effect—which is made up only of patients who either hadn’t used ASA at all or patients who had stopped the use of ASA medication at or before the recommended time (>=7 days prior to operation); (2) ASA effect—all patients who had not discontinued ASA use within the recommended time frame. The second model consists of three groups: (1) No ASA application; (2) Stopped ASA application (>=7 days prior to operation); (3) Continued ASA application (did not stop use <7 days prior to operation or did not stop use at all). Data collected included demographic information, surgical parameters, aneurysm characteristics, and all hemorrhagic/thromboembolic complications. A postoperative hemorrhage was defined as relevant if a subsequent operation for hematoma removal was necessary.
Results: An ASA effect appears to have occurred in 32 out of 200 performed operations. In only one out of these 32 patients did a postoperative hemorrhage occur (3.13%). Postoperative hemorrhages in patients without any ASA impact were detected and treated in 5 out of 168 patients (2.98%). The difference between the two was minimal and thus not significant (ASA effect vs. No ASA effect: OR = 1.0516 [0.1187; 9.3132], p=1.000; RR = 1.0015 [0.9360; 1.0716]).
Conclusion: The results of this study indicate that continued ASA use is not associated with an increased risk of postoperative hemorrhage. In patients with high cardiovascular risk, and in the case of emergency surgery, ASA can safely be continued.