Kulikov A, Konovalov A, Pugnaloni PP, Bilotta F. Aspirin interruption before neurosurgical interventions: A controversial problem. World J Cardiol 2024; 16(4): 191-198 [PMID: 38690214 DOI: 10.4330/wjc.v16.i4.191]
Corresponding Author of This Article
Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “Sapienza”, Policlinico Umberto I, Viale del Policlinico 37, Rome 00161, Italy. bilotta@tiscali.it
Research Domain of This Article
Health Care Sciences & Services
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2024; 16(4): 191-198 Published online Apr 26, 2024. doi: 10.4330/wjc.v16.i4.191
Aspirin interruption before neurosurgical interventions: A controversial problem
Alexander Kulikov, Anton Konovalov, Pier Paolo Pugnaloni, Federico Bilotta
Alexander Kulikov, Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow 125047, Russia
Anton Konovalov, Department of Vascular Neurosurgery, Burdenko National Medical Research Center of Neurosurgery, Moscow 125047, Russia
Pier Paolo Pugnaloni, Federico Bilotta, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “Sapienza”, Rome 00161, Italy
Author contributions: Kulikov A, Bilotta F designed the research; Kulikov A, Konovalov A, Pugnaloni PP performed the research; Kulikov A, Konovalov A, Bilotta F analyzed the data and wrote the paper.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
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 Non-Commercial (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: Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “Sapienza”, Policlinico Umberto I, Viale del Policlinico 37, Rome 00161, Italy. bilotta@tiscali.it
Received: December 27, 2023 Peer-review started: December 27, 2023 First decision: January 17, 2024 Revised: January 26, 2024 Accepted: February 29, 2024 Article in press: February 29, 2024 Published online: April 26, 2024
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.
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.
