SynthesisActa neurochirurgica2023
Risks and benefits of continuation and discontinuation of aspirin in elective craniotomies: a systematic review and pooled-analysis.
Synthesis in Acta neurochirurgica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Early initiation of low-dose aspirin for the prevention of pre-eclampsia in high-risk pregnancies.Scientific reports · 2026Trial
- Delayed evacuation of bilateral chronic subdural hematoma with herniation-induced bilateral posterior cerebral artery infarction: illustrative case.Journal of neurosurgery. Case lessons · 2026Article
- The impact of perioperative aspirin utilization on postoperative hemorrhagic complications in idiopathic normal pressure hydrocephalus: a single-center retrospective analysis.Neurosurgical review · 2025Article
- Balancing bleeding, thrombosis and myocardial injury: A call for balance and precision medicine for aspirin in neurosurgery.World journal of cardiology · 2024Article
- Risk of Postoperative Hemorrhage After Glioma Surgery in Patients with Preoperative Acetylsalicylic Acid.Cancers · 2024Article
- Impact of Perioperative Acetylsalicylic Acid (ASA) Administration on Postoperative Intracranial Hemorrhage (pICH) and Thromboembolic Events in Patients with Intracranial Meningiomas.Journal of clinical medicine · 2024Article
- Aspirin interruption before neurosurgical interventions: A controversial problem.World journal of cardiology · 2024Review
- Challenges in Coagulation Management in Neurosurgical Diseases: A Scoping Review, Development, and Implementation of Coagulation Management Strategies.Journal of clinical medicine · 2023Article
- Anticoagulation Options for Cranial Procedures: A Comparative Review of Aspirin, Plavix, and Aggrastat.Cureus · 2023Review
- Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report.Frontiers in surgery · 2022Article
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Authors and funding
7 authors.
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Abstract
BACKGROUND/
aimDiscontinuation 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.
methodsPubMed 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.
resultsOut 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).
conclusionPerioperative 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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