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April 9, 2019Journal of neurosurgery

Effect of perioperative aspirin use on hemorrhagic complications in elective craniotomy for brain tumors: results of a single-center, retrospective cohort study

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Key result

Perioperative aspirin use was not associated with an increased rate of hemorrhagic complications compared to stopping or no aspirin (0.8% vs 0.9% vs 0.6%; p=0.921).

Why the study?

Limited data existed on whether perioperative aspirin use increases the risk of hemorrhagic complications during elective intracranial surgery.

Does continuing perioperative aspirin increase hemorrhagic complications in patients undergoing elective craniotomy for brain tumors?

Population

1291 patients undergoing elective intracranial tumor surgery by a single surgeon

Comparison

No ASA vs stopped ASA vs continued ASA

Design

Single-center retrospective cohort study

Authors

ŞHŞahin HanalıoğluBŞBalkan ŞahinÖŞÖmer Selçuk Şahin

Discussion

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Overview

May support perioperative aspirin continuation in neurosurgery; hypothesis-generating and leaves open need for randomized confirmation.

Key Points

  • To determine whether continuing perioperative aspirin therapy increases the incidence of hemorrhagic complications in patients undergoing elective craniotomy for brain tumors.
  • Retrospectively analyzed 1291 patients (1346 elective intracranial tumor operations) treated by a single neurosurgeon between 2007 and 2017.
  • Stratified patients into three cohorts: no aspirin (N=1068; 1112 operations), stopped aspirin 7–10 days preoperatively (N=104; 108 operations), and continued perioperative aspirin (N=119; 126 operations).
  • Evaluated operative blood loss, extent of resection, and rates of postoperative hemorrhagic and thromboembolic complications using univariate and multivariate analyses.
  • Hemorrhagic complication rates were 0.6% in the no-aspirin group, 0.9% in the stopped-aspirin group, and 0.8% in the continued-aspirin group (p = 0.921).
  • Thromboembolic complication rates were 1.3% (no aspirin), 1.9% (stopped aspirin), and 0.8% (continued aspirin; p = 0.779), with no significant difference in blood loss between stopped (186 ml) and continued (220 ml) cohorts (p = 0.183).
  • Multivariate regression revealed no independent predictors of hemorrhagic complications, but identified male sex (OR 5.9, 95% CI 1.7–20.5, p = 0.005) and skull base tumors (OR 3.6, 95% CI 1.3–9.7, p = 0.011) as independent predictors of thromboembolic events.

Study Design

Type

Cohort (n=1,291)

Multicenter

No

Structured PICO

Does continuing perioperative aspirin increase hemorrhagic complications in patients undergoing elective craniotomy for brain tumors?

P
Population
1,291 patients undergoing elective craniotomy for brain tumors, categorized by perioperative aspirin use status.
E
Exposure
Continued perioperative aspirin (ASA) (high cardiovascular risk group, n=119 patients, 126 operations)
C
Comparator
No aspirin (n=1,068 patients, 1,112 operations) or stopped aspirin (low cardiovascular risk group, n=104 patients, 108 operations)
O
Outcome
Hemorrhagic complicationssafety

Main Result

Absolute Event Rate: 0.8% vs 0.6%

p-value: p=0.921

Continuing aspirin perioperatively in high cardiovascular risk patients undergoing elective brain tumor surgery does not appear to increase hemorrhagic complications.

Limitations

  • Retrospective design
  • Limited statistical power requiring larger randomized clinical trials
  • Single-center
  • Single surgeon
  • Need for larger randomized clinical trials to achieve greater statistical power

Cite This Study

Hanalıoğlu et al. (2019) conducted a cohort in Brain tumors requiring elective craniotomy (n=1,291). Perioperative aspirin (ASA) use vs. No aspirin or stopped aspirin was evaluated on Hemorrhagic complications (p=0.921). Perioperative aspirin use was not associated with an increased rate of hemorrhagic complications compared to stopping or no aspirin (0.8% vs 0.9% vs 0.6%; p=0.921).

synapsesocial.com/papers/6a9e5b599b2dbee2f9368988https://doi.org/10.3171/2018.12.jns182483
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