Key result
Current clinical evidence does not support the routine discontinuation of long-term aspirin therapy before neurosurgical procedures, as it does not appear to increase the risk of postoperative hemorrhage.
Why the study?
Clinical evidence is lacking to support recommendations that aspirin be stopped for at least a week before neurosurgical intervention, despite bleeding risks associated with chronic use.
Does continuing chronic aspirin therapy increase bleeding risk in patients undergoing neurosurgery compared to aspirin interruption?
Does continuing chronic aspirin therapy increase bleeding risk in patients undergoing neurosurgery compared to aspirin interruption?
Current evidence may not support the routine interruption of aspirin prior to neurosurgery, challenging existing ESC guidelines.
May support continuing aspirin in neurosurgery without added bleeding risk; leaves open need for RCTs before changing practice.
Aspirin is frequently used to prevent ischemia episodes, either directly or indirectly. Chronic aspirin use can also increase intraoperative blood loss and have an impact on blood clot development during surgery. This is particularly crucial for neurosurgery and other high-risk surgeries. There is currently no clinical evidence to support the European Society of Cardiology's recommendation that aspirin be stopped for at least a week prior to neurosurgical intervention. In addition to summarizing current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients, including brain tumour surgery, cerebrovascular procedures, and spinal surgery, this narrative review presents evidence that casts doubt on the need for aspirin interruption in neurosurgical patients. It also discusses options for aspirin effect monitoring and the clinical implications of these methods.
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Suryapratap Singh Tomar (2025) conducted a review in Neurosurgery. Aspirin continuation vs. Aspirin discontinuation was evaluated on Postoperative bleeding risk. Current clinical evidence does not support the routine discontinuation of long-term aspirin therapy before neurosurgical procedures, as it does not appear to increase the risk of postoperative hemorrhage.
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