title: Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Previous studies have indicated an increased incidence of death in patients with subarachnoid hemorrhage (SAH) who are currently receiving anticoagulation therapy. The significance of previous aspirin use in patients with SAH is unknown. The authors analyzed the effects of prior aspirin use on clinical course and outcomes following aneurysmal SAH.
  
  
  METHODS
  The medical records of 305 patients with angiogram-confirmed aneurysmal SAH who consecutively presented to our institution between 1990 and 1997 within 7 days of ictus were analyzed. Twenty-nine (9.5%) of these patients had a history of regular aspirin use before onset of the SAH. The Glasgow Outcome Scale (GOS) was used to measure patient outcome at the longest available follow up. Aspirin users were older on average than nonusers (59 years of age compared with 53 years; p = 0.018). The mean admission Hunt and Hess grades of patients with and without aspirin use were similar (2 compared with 2.3; p = 0.51). Two trends, which did not reach statistical significance, were observed. 1) The rebleeding rate in aspirin users was 14.3%, compared with a 4.7% rebleeding rate in nonusers (p = 0.06). 2) Permanent disability from vasospasm was less common among aspirin users (23% compared with 50%; p = 0.069). Outcomes did not differ between aspirin users and nonusers (mean GOS Score 3.83 compared with GOS Score 3.86, respectively; p = 0.82).
  
  
  CONCLUSIONS
  Despite trends indicating increased rebleeding rates and a lower incidence of permanent disability due to delayed ischemic neurological deficits, there was no significant effect of previous aspirin use on overall outcome following aneurysmal SAH. Based on these preliminary data, the presence of an intracranial aneurysm is not a strict contraindication to aspirin use.
authors.affiliation: Department of Neurologic Surgery, Mayo Graduate School of Medicine, Rochester, Minnesota 55905, USA. Toussaint.Gerard@mayo.edu
authors.forename: L Gerard
authors.initials: LG
authors.lastname: Toussaint
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Friedman
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
authors.forename: David G
authors.initials: DG
authors.lastname: Piepgras
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pichelmann
authors.forename: Jon I
authors.initials: JI
authors.lastname: McIver
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Nichols
authors.forename: Fredric B
authors.initials: FB
authors.lastname: Meyer
authors.forename: John L D
authors.initials: JL
authors.lastname: Atkinson
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012008:Recurrence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin