title: Aspirin and aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Recent evidence has suggested a potential beneficial effect of aspirin on the risk of aneurysm rupture. This benefit must be weighed against its potential adverse effects as an antiplatelet agent in the setting of acute aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  A total of 747 consecutive patients with cerebral aneurysms were reviewed, comparing demographics, aneurysm features, presenting clinical and radiographic grades, vasospasm, and outcome at 1 year between patients with aneurysmal SAH taking aspirin on presentation and those who were not.
  
  
  RESULTS
  The rate of hemorrhagic presentation was significantly greater in patients not taking aspirin (40% vs. 28%; P = 0.016). Among 274 patients presenting with aneurysmal SAH, there was no significant difference in presenting clinical (Hunt and Hess) and radiographic (Fisher) grade between patients taking aspirin and those who were not. There was also no significant difference in the rate of subsequent angiographic and delayed cerebral ischemia. Multivariate analysis of outcome at 1 year found only increasing age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.04-1.12), Hunt and Hess grade (OR 3.01, 95% CI 1.81-5.03), and associated hypertension (OR 3.30, 95% CI 1.39-7.81) to be statistically significant risk factors for poor outcome (death or dependence), whereas aspirin use was not associated with poor outcome (OR 1.19, 95% CI 0.35-4.09; P = 0.78).
  
  
  CONCLUSIONS
  In the present study, patients taking aspirin had a lower rate of hemorrhagic presentation. In addition, taking aspirin did not adversely impact presenting clinical grade or radiographic grade, vasospasm, and outcome in the setting of aneurysmal SAH.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pui Man
authors.initials: PM
authors.lastname: Rosalind Lai
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rdu@partners.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000293:Adolescent; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000517:prevention & control*; D001241:Aspirin / Q000627:therapeutic use*; D002533:Cerebral Angiography; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Aneurysm; Antiplatelet; Aspirin; Hemorrhage; Natural history; Outcome; Rupture