Aspirin interruption before neurosurgical interventions: A controversial problem

Table 1 Characteristics of included studies on aspirin consumption before neurosurgical interventions

Ref.	No. of patients	Reported schemes	Key message
Brain tumor surgery
Merriman et al[19], 1979	2	4-20 tablets of aspirin 325 mg/d	Complications could be associated with preoperative aspirin consumption
Case report
Hanalioglu et al[20], 2019	1291	3 groups:	ASA was not associated with increased bleeding risk
Retrospective single-center, cohort study		No ASA (1068 patients)
		Stopped ASA (at least 7 d before surgery – 104 patients)
		Continued ASA (119 patients)
Rychen et al[21], 2023	312	ASA was continued perioperatively for extraaxial surgery, and discontinued 2 d before intraaxial surgery (83 patients). No ASA in prospective control (106 patients) and long-term ASA discontinuation in retrospective control group (123 patients)	Presented protocol of perioperative antithrombotics management was not associated with an increased hemorrhagic risk
Prospective cohort study with retrospective control
Enciu et al[22], 2023	304	2 groups:	Short-term (even < 2 d) discontinuation of low-dose aspirin was not associated with increased bleeding risk
Retrospective single-center, cohort study		Short-term ASA discontinuation (lower than 7 d) (45 patients)
		Standard-term ASA discontinuation (259 patients)
Rychen et al[7], 2023	646 (7 studies)	ASA was continued perioperatively in 61.8% and discontinued in 38.2% of the cases	Perioperative ASA continuation in elective craniotomies was not associated with an increased hemorrhagic risk
Systematic review
Cerebrovascular surgery
Schubert et al[23], 2014	158	ASA was prescribed in 138 patients pre- or intraoperatively	Antiplatelet therapy did not increase the risk of hemorrhage, but improved outcomes after revascularization procedures
Retrospective single-center, cohort study
Nakamizo et al[24], 2017	401	2 groups:	Intracranial hemorrhage after aneurism clipping was more frequent in the antithrombotics group
Retrospective single-center, cohort study		Continued antithrombotics, including ASA (45 patients)
		No antithrombotics (259 patients)
Rashidi et al[25], 2021	200	2 groups:	Continued ASA use was not associated with an increased risk of a postoperative hemorrhage
Retrospective single-center, cohort study		Continued ASA or short-term ASA discontinuation (lower than 7 d) (32 patients)
		No ASA (168 patients)
Ebel et al[26], 2021	215	2 groups:	Short (≤ 5 d) aspirin discontinuation time did not appear to have increased rates of postoperative bleeding
Retrospective single-center, cohort study		Patients were treated with antithrombotics (50 patients)
		No antithrombotics (165 patients)
Spinal surgery
Goes et al[6], 2017	370 (3 studies)	2 groups:	There is no difference in perioperative complications between aspirin continuation and discontinuation
Meta-analysis		ASA-continuing group (170 patients)
		ASA-discontinuing group (200 patients)
Zhang et al[29], 2017	414 (4 studies)	2 groups:	Continued aspirin administration do not have an increased risk for bleeding
Meta-analysis		ASA-continuing group
		ASA-discontinuing group
Cheng et al[30], 2018	1173 (7 studies)	3 groups:	No difference in intraoperative blood loss, operation time, and postoperative complications
Systematic review		No ASA therapy (587 patients)
		Stopped ASA (3-10 d before surgery – 416 patients)
		Continued ASA (170 patients
Claydon et al[28], 2022	364	2 groups:	There was no association of low-dose ASA continuation with increased blood loss
Prospective, multi-center observational cohort study		ASA-continuing group (21 patients)
		No ASA group
Tarukado et al[27], 2023	88	3 groups:	Continuing ASA did not affect perioperative complications or clinical outcomes
Retrospective single-center, cohort study		No antithrombotics (65 patients)
		Stopped ASA (9 patients)
		Continued ASA (14 patients)

ASA: Aspirin.