title: Does Early Resumption of Low-Dose Aspirin After Evacuation of Chronic Subdural Hematoma With Burr-Hole Drainage Lead to Higher Recurrence Rates?
abstract: BACKGROUND
  Antiplatelet therapy in patients with chronic subdural hematoma (cSDH) presents significant neurosurgical challenges. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, it is difficult to balance the patient's increased cardiovascular risk and prevalence of cSDH.
  
  
  OBJECTIVE
  To better understand the risk and recurrence rates related to resuming low-dose acetylsalicylic acid (ASA) by evaluating our patients' resumption of low-dose ASA at various times after burr-hole drainage of the hematoma.
  
  
  METHODS
  In our retrospective study, 140 consecutive patients taking low-dose ASA undergoing surgical evacuation of cSDH were included. Data included baseline characteristics and rates of recurrence, morbidity, and mortality. A multivariate logistic regression model analyzed the association between ASA resumption time and recurrence rates.
  
  
  RESULTS
  No statistically significant association was observed between early postoperative resumption of low-dose ASA and recurrence of cSDH (odds ratio, 1.01; 95% confidence interval, 1.001-1.022; P = .06). Corresponding odds ratios and risk differences for restarting ASA treatment on postoperative days 1, 7, 14, 21, 28, 35, or 42 were estimated at 1.53 and 5.9%, 1.42 and 5.1%, 1.33 and 4.1%, 1.23 and 3.2%, 1.15 and 2.2%, 1.07 and 1.1%, and 1.01 and 0.2%, respectively (P > .05). Cardiovascular event rates, surgical morbidity, and mortality did not significantly differ between patients with or without ASA therapy.
  
  
  CONCLUSIONS
  Given the few published studies regarding ASA use in cranial neurosurgery, our findings elucidate one issue, showing comparable recurrence rates with early or late resumption of low-dose ASA after burr-hole evacuation of cSDH.
  
  
  BACKGROUND
  ASA, acetylsalicylic acidCAD, coronary artery diseaseCI, confidence intervalcSDH, chronic subdural hematomaGCS, Glasgow Coma ScalemRS, modified Rankin ScaleOR, odds ratioRD, risk difference.
authors.affiliation: ‡Department of Neurosurgery and¶Clinical Trial Unit, University Hospital of Basel, Basel, Switzerland;§Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kamenova
authors.forename: Katharina
authors.initials: K
authors.lastname: Lutz
authors.forename: Sabine
authors.initials: S
authors.lastname: Schaedelin
authors.forename: Javier
authors.initials: J
authors.lastname: Fandino
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Jehuda
authors.initials: J
authors.lastname: Soleman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D003399:Craniotomy; D004322:Drainage; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin