Association between discontinuation of aspirin and perioperative bleeding or ischemic events before neurosurgery

doi:10.16352/j.issn.1001-6325.2022.02.015

Abstract

Abstract: The problem with discontinuation of aspirin during the perioperative period is that the patient is in a hypercoagulable state, which increases the occurrence of embolism event. However, continued use during the perioperative period may increase the risk of bleeding. This article reviews the bleeding and ischemic risks of stop use aspirin before neurosurgery, in order to guide the clinical practice.

Key words: aspirin, bleeding, ischemia, neurosurgery

CLC Number:

R973+.2

WANG Xin-yan, WANG Xin-xin, YU Yun, HAN Ru-quan. Association between discontinuation of aspirin and perioperative bleeding or ischemic events before neurosurgery[J]. Basic & Clinical Medicine, 2022, 42(2): 330-334.

References

[1]Patrono C, Morais J, Baigent C, et al.Antiplatelet agents for the treatment and prevention of coronary Atherothrombosis[J].J Am Coll Cardiol,2017,70:1760-1776.
[2]Montinari MR, Minelli S, De Caterina R. The first 3 500 years of aspirin history from its roots-a concise summary[J].Vascul Pharmacol,2019,113:1-8.
[3]Weiser TG, Haynes AB, Molina G, et al.Size and distribution of the global volume of surgery in 2012[J].Bull World Health Organ,2016,94:201-209.
[4]Rose J, Weiser TG, Hider P, et al.Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate[J].Lancet Glob Health,2015,3 Suppl 2(Suppl 2):S13-20.
[5]Lewis SR, Pritchard MW, Schofield-Robinson OJ, et al.Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non-cardiac surgery[J].Cochrane Database Syst Rev,2018,7:Cd012584. doi:10.1002/14651858.CD012584.pub2.
[6]Chan FKL, Kyaw MH, Hsiang JC, et al.Risk of postpolypectomy bleeding with uninterrupted clopidogrel therapy in an industry-independent, double-blind, randomized trial[J].Gastroenterology,2019,156:918-925.
[7]Cheng A, Poon MTC,Demetriades AK.Aspirin therapy discontinuation and intraoperative blood loss in spinal surgery: a systematic review[J].Neurosurg Rev,2018,41:1029-1036.
[8]Mitchell JA, Kirkby NS, Ahmetaj-Shala B, et al.Cyclooxygenases and the cardiovascular system[J].Pharmacol Ther,2021,217:107624. doi:10.1016/j.pharmthera.2020.107624.
[9]赵艳秋,梁伟, 洪玉娥. 老年患者阿司匹林抵抗发生率及其相关危险因素分析[J].基础医学与临床,2021,41:1035-1038.
[10]Wang Y, Wang Y, Zhao X, et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2013,369:11-19.
[11]Wang Y, Meng X, Wang A, et al.Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA[J].N Engl J Med,2021. doi: 10.1056/NEJMoa2111749.
[12]Burn J, Sheth H, Elliott F, et al.Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial[J].Lancet,2020,395:1855-1863.
[13]Columbo JA, Lambour AJ, Sundling RA, et al.A Meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncar-diac surgery[J].Ann Surg,2018,267:1-10.
[14]韦敏,钟海燕,都义日,等.腹腔镜手术老年患者围术期停用阿司匹林的风险-收益评价[J].中华麻醉学杂志,2019,5:526-529.
[15]Antolovic D, Rakow A, Contin P, et al.A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery--the APAP trial (ISRCTN45810007)[J].Langenbecks Arch Surg,2012,397:297-306.
[16]Chu EW, Chernoguz A, Divino CM.The evaluation of clopidogrel use in perioperative general surgery patients: a prospective randomized controlled trial[J].Am J Surg,2016,211:1019-1025.
[17]Mantz J, Samama CM, Tubach F, et al.Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial[J].Br J Anaesth,2011,107:899-910.
[18]Bogunovic L, Haas AK, Brophy RH, et al.The perioperative continuation of aspirin in patients undergoing arthroscopic surgery of the knee[J].Am J Sports Med,2019,47:2138-2142.
[19]王梓,夏利民,宋凯,等. 不停跳冠状动脉旁路移植术前停用阿司匹林及氯吡格雷对术后出血和输血的影响[J].中华外科杂志,2019,3:187-193.
[20]Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25:603-605.
[21]Scerrati A, Germanò A, Trevisi G, et al.Timing of low-dose aspirin discontinuation and the influence on clinical outcome of patients undergoing surgery for chronic subdural hematoma[J].World Neurosurg,2019,129:e695-e699. doi: 10.1016/j.wneu.2019.05.252.
[22]Lee AT, Gagnidze A, Pan SR, et al.Preoperative low-dose aspirin exposure and outcomes after emergency neurosurgery for traumatic intracranial hemorrhage in elderly patients[J].Anesth Analg,2017,125:514-520.
[23]Cuellar JM, Petrizzo A, Vaswani R, et al.Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?[J].Spine (Phila Pa 1976),2015,40:629-635.
[24]Park HJ, Kwon KY, Woo JH.Comparison of blood loss according to use of aspirin in lumbar fusion patients[J].Eur Spine J,2014,23:1777-1782.
[25]Soleman J, Baumgarten P, Perrig WN, et al.Non-instrumented extradural lumbar spine surgery under low-dose acetylsalicylic acid: a comparative risk analysis study[J].Eur Spine J,2016,25:732-739.