Key result
Perioperative continuation of aspirin in elective craniotomies did not increase the risk of hemorrhagic complications compared to discontinuation (3% vs 3%, RR 0.83).
Why the study?
Discontinuation of aspirin before elective craniotomies is common practice, but patients on secondary prevention face higher thromboembolic risk, leaving the risks and benefits of continuation versus discontinuation unclear.
Does perioperative continuation of aspirin increase hemorrhagic complications or reduce thromboembolic complications in patients undergoing elective craniotomies?
Systematic Review (n=646)
Does perioperative continuation of aspirin increase hemorrhagic complications or reduce thromboembolic complications in patients undergoing elective craniotomies?
Relative Risk: 0.83 (95% CI 0.29–2.35)
Absolute Event Rate: 3% vs 3%
p-value: p=0.9
Perioperative continuation of aspirin in elective craniotomies appears safe regarding hemorrhagic risk and may offer a trend toward protection against thromboembolic events, particularly for secondary prevention.
ASA continuation appears safe without excess bleeding in elective craniotomy; supports secondary prevention while leaving optimal strategy open for RCTs.
BACKGROUND/AIM: Discontinuation of aspirin (ASA) prior to elective craniotomies is common practice. However, patients treated with ASA for secondary prevention bear a higher risk for thromboembolic complications. Aim of this systematic review is to investigate the risks and benefits of perioperative continuation and discontinuation of ASA in elective craniotomies. METHODS: PubMed and Embase databases were searched. Inclusion criteria were retro- and prospective studies, reporting hemorrhagic and thromboembolic complications in patients in whom ASA was either continued or discontinued perioperatively in elective craniotomies. We excluded shunt operations and emergency cases. The MINORS (Methodological index for non-randomized studies) score was used to quantify the methodological quality of the eligible studies. RESULTS: Out of 523 publications, 7 met the eligibility criteria (cumulative cohort of 646 patients). The mean MINORS score for the comparative studies was 18.7/24 (± SD 2.07, range: 17-22) and 9/16 for the unique non-comparative study, indicating an overall weak methodological quality of the included studies. 57.1% of the patients underwent craniotomy for intra- and extra-axial tumor removal, 39.0% for bypass surgery and 3.9% for neurovascular lesions (other than bypass). In 31.0% of the cases, ASA was prescribed for primary and in 69.0% for secondary prevention. ASA was continued perioperatively in 61.8% and discontinued in 38.2% of the cases. The hemorrhagic complication rate was 3% (95% CI [0.01-0.05]) in the ASA continuation group (Con-Group) and 3% (95% CI [0.01-0.09]) in the discontinuation group (Disc-Group) (p = 0.9). The rate of thromboembolic events in the Con-Group was 3% (95% CI [0.01-0.06]) in comparison to 6% (95% CI [0.02-0.14]) in the Disc-Group (p = 0.1). CONCLUSION: Perioperative continuation of ASA in elective craniotomies does not seem to be associated with an increased hemorrhagic risk. The potential beneficial effect of ASA continuation on thromboembolic events needs to be further investigated in patients under ASA for secondary prevention.
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Rychen et al. (2022) conducted a systematic review in Elective craniotomies (n=646). Aspirin (ASA) continuation vs. Aspirin discontinuation was evaluated on Hemorrhagic complications (RR 0.83, 95% CI 0.29-2.35, p=0.9). Perioperative continuation of aspirin in elective craniotomies did not increase the risk of hemorrhagic complications compared to discontinuation (3% vs 3%, RR 0.83).
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