Balancing bleeding, thrombosis and myocardial injury: A call for balance and precision medicine for aspirin in neurosurgery

doi:10.4330/wjc.v16.i12.673

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Dec 26, 2024 (publication date) through Nov 26, 2024

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Cardiol. Dec 26, 2024; 16(12): 673-676
Published online Dec 26, 2024. doi: 10.4330/wjc.v16.i12.673

Balancing bleeding, thrombosis and myocardial injury: A call for balance and precision medicine for aspirin in neurosurgery

Subhrashis Guha Niyogi, Akash Batta, Bishav Mohan

Subhrashis Guha Niyogi, Department of Anesthesia, Tata Main Hospital, Jamshedpur 831001, Jharkhand, India

Akash Batta, Bishav Mohan, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Author contributions: Niyogi SG and Batta A designed the editorial; Niyogi SG performed the literature review and data collection; Mohan B and Batta A supervised the study and provided key feedback and suggestions; Niyogi SG and Batta A analysed the data and wrote the manuscript and subsequently revised it; and all authors have read and approved the final manuscript.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.

Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Akash Batta, DM, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com

Received: May 27, 2024
Revised: October 4, 2024
Accepted: October 29, 2024
Published online: December 26, 2024
Processing time: 182 Days and 17.6 Hours

Core Tip

Core Tip: The decision to continue or discontinue aspirin during the perioperative period is nuanced and must be tailored to each patient. The procedure-related bleeding risks of neurosurgery must be weighed against the potential patient-specific risks of thromboembolism, major adverse cardiac events as well as subclinical myocardial injury after non-cardiac surgery (MINS). MINS increases the risk of both early and late postoperative morbidity and mortality and can be triggered by prolonged (≥ 7 days) cessation of antiplatelets. Practice guidelines incorporating the latest evidence and point-of-care tests of platelet function are possible aids in this complicated scenario.