Risk assessment of rebleeding after cerebral hemorrhage surgery for oral administration of aspirin

Abstract

Objective To investigate the rebleeding risk after cerebral hemorrhage surgery for oral administration of aspirin and the development of treatment decision. Methods A total of 306 patients with intracerebral hemorrhage surgery with a history of oral administration of aspirin at the Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University from January 2009 to December 2014 were analyzed retrospectively. The influencing factors of postoperative rebleeding were analyzed by using a case-control study. Preoperative thrombelastography (TEG) was used to examine the arachidonic acid (AA) pathway induced platelet inhibition rate, and the inhibition rate ≥75% was used as the criterion of postponing emergency surgery. The postoperative rebleeding risk differences between the different treatment regimens and between the different surgical procedures were compared. Results The postoperative rebleeding rate of the inhibition rate ≥75% group was 26.9%, the delayed surgery group was 4.1% (OR, 8.566, 95% CI 2.279-32.190; P=0.001). The rebleeding rate of the inhibition rate <75% group was 7.6% (OR, 1.923, 95% CI 0.594-6.224; P=0.275); the inhibition rate ≥75% group compared with the inhibition rate <75% group (OR, 4.455, 95% CI 1.539-12.891; P=0.006). The emergency craniotomy group compared with the delayed surgery group, the rebleeding rate was 15.9% (OR, 4.399, 95% CI 1.215-15.919; P=0.024). Conclusions The platelet inhibition rate ≥75% induced by AA pathway can be used as a predictor for the high risk of postoperative rebleeding in patients with cerebral hemorrhage for oral administration of aspirin. The surgical methods and treatment choice can be chosen reasonably according to the own experiences and technological advantages of surgeons Key words: Cerebral hemorrhage; Aspirin; Neurosurgical procedures; Thrombelastography