title: Does aspirin administration increase perioperative morbidity in patients with cardiac stents undergoing spinal surgery?
abstract: METHODS
  Cohort.
  
  
  OBJECTIVE
  To compare the perioperative morbidity of patients with cardiac stents after spine surgery who continue to take aspirin before and after the operation with a similar group of patients who preoperatively discontinued aspirin.
  
  
  BACKGROUND
  The preoperative discontinuation of anticoagulant therapy has been the standard of care for orthopedic surgical procedures. However, recent literature has demonstrated significant cardiac risk associated with aspirin withdrawal in patients with cardiac stents. Although it has recently been demonstrated that performing orthopedic surgery while continuing low-dose aspirin therapy seems to be safe, studies focused on spinal surgery have not yet been performed. Because of the risk of intraspinal bleeding and the serious consequences of subsequent epidural hematoma with associated spinal cord compression, spinal surgeons have been reluctant to operate on patients taking aspirin.
  
  
  METHODS
  This institutional review board-approved study included 200 patients. Preoperative parameters and postoperative outcome measures were analyzed for 100 patients who underwent spinal surgery after the discontinuation of anticoagulation therapy and 100 patients who continued to take daily aspirin through the perioperative period. The primary outcome measure was serious bleeding-related postoperative complications such as spinal epidural hematoma. The operative time, intraoperative estimated blood loss, hospital length of stay, transfusion of blood products, and 30-day hospital readmission rates were also recorded and compared.
  
  
  RESULTS
  The patients who continued taking aspirin in the perioperative period had a shorter hospital length of stay on average (4.1 ± 2.7 vs. 6.2 ± 5.8; P < 0.005), as well as a reduced operative time (210 ± 136 vs. 266 ± 143; P < 0.01), whereas there was no significant difference in the estimated blood loss (642 ± 905 vs. 697 ± 1187), the amount of blood products transfused, overall intra- and postoperative complication rate (8% vs. 11%), or 30-day hospital readmission rate (5% vs. 5%). No clinically significant spinal epidural hematomas were observed in either of the study groups.
  
  
  CONCLUSIONS
  The current study has observed no appreciable increase in bleeding-related complication rates in patients with cardiac stents undergoing spine surgery while continuing to take aspirin compared with patients who discontinued aspirin prior to surgery. Although very large studies will be needed to determine whether aspirin administration results in a small complication rate increase, the current study provides evidence that perioperative aspirin therapy is relatively safe in patients undergoing spinal surgery.
  
  
  METHODS
  2.
authors.affiliation: *Department of Orthopaedic Surgery and †Division of spine surgery, NYU Hospital for Joint Diseases, New York, NY; and ‡NYU School of Medicine, New York, NY.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Cuellar
authors.forename: Anthony
authors.initials: A
authors.lastname: Petrizzo
authors.forename: Ravi
authors.initials: R
authors.lastname: Vaswani
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D013131:Spine / Q000601:surgery*; D015607:Stents; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin