Evaluating the safety of early surgery for ruptured intracranial aneurysms in patients with long-term aspirin use: a propensity score matching study

Maogui Li,Yong Cao,Shuzhe Yang,Shuo Wang,Qingyuan Liu,Jun Wu,Rui Guo

doi:10.1186/s41016-020-00216-y

Maogui Li, Yong Cao + Show 5 more

Open Access

https://doi.org/10.1186/s41016-020-00216-y

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Abstract

BackgroundEarly microsurgical clipping is recommended for ruptured intracranial aneurysms to prevent rebleeding. However, dilemma frequently occurs when managing patients with current acetylsalicylic acid (aspirin) use. This study aimed to examine whether aspirin use was associated with worse outcomes after early surgery for aneurysmal subarachnoid hemorrhage (aSAH).MethodsWe retrieved a consecutive series of 215 patients undergoing early microsurgical clipping within 72 h after aneurysmal rupture from 2012 to 2018 in the neurosurgery department of Beijing Tiantan Hospital. The medical records of each case were reviewed. Twenty-one patients had a history of long-term aspirin use before the onset of aSAH, and 194 patients did not. To reduce confounding bias, propensity score matching (PSM) was performed to balance some characteristics of the two groups. The intraoperative blood loss, postoperative hemorrhagic events, postoperative hospital stay, and functional outcome at discharge were compared between aspirin and non-aspirin group.ResultsWe matched all the 21 patients in aspirin group with 42 patients in non-aspirin group (1:2). Potential confounding factors were corrected between the two groups by PSM. No hospital mortality occurred after surgery. No significant differences were found in intraoperative blood loss (P = 0.540), postoperative hemorrhagic events (P > 0.999), postoperative hospital stay (P = 0.715), as well as functional outcome at discharge (P = 0.332) between the two groups.ConclusionsOur preliminary results showed that long-term low-dose aspirin use was not associated with worse outcomes. Early surgery can be safe for ruptured intracranial aneurysms in patients with long-term aspirin use.

Highlights

Microsurgical clipping is recommended for ruptured intracranial aneurysms to prevent rebleeding
We included the patients with the following inclusion criteria: (1) SAH confirmed by plain computed tomography (CT), with responsible aneurysms detected by CT angiography (CTA)
After the 1:2 propensity score matching (PSM), 42 matched patients were extracted from the nonaspirin group

Summary

Introduction

Microsurgical clipping is recommended for ruptured intracranial aneurysms to prevent rebleeding. Because of the serious consequences of intracranial hemorrhage, many surgeons suggested aspirin therapy be stopped for more than 7 days before elective neurosurgery to avoid the increased bleeding risk [7, 8]. This option does not apply to emergency situation. A recent traumatic neurosurgical study found that low-dose aspirin use without preoperative cessation was not associated with unfavorable outcomes after emergency surgery for traumatic intracranial hemorrhage [13]. Further evidence on the safety of early surgery in aSAH patients with long-term aspirin use is needed

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