Aspirin interruption before neurosurgical interventions: A controversial problem

Abstract

Aspirin is widely used for primary or secondary prevention of ischemic events. At the same time, chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss. This is especially important for high-risk surgery, including neurosurgery. Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention, but this suggestion is not supported by clinical evidence. This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients, describes options for aspirin effect monitoring and the clinical implication of these methods, and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients, including brain tumor surgery, cerebrovascular procedures, and spinal surgery.

Keywords: Aspirin; Neurosurgery; Postoperative complications; Bleeding risk; Brain tumor surgery; Cerebrovascular surgery; Spinal surgery

Core Tip: A decision on continuing or interrupting aspirin use before neurosurgical intervention should be made based on a discussion of specialists involved in perioperative management (neurosurgeon, anesthesiologist, cardiologist, etc), taking into account estimated blood loss; risk of complications associated with increased bleeding time; risk of postoperative ischemic complication associated with aspirin interruption; and risk of surgery postponement.