title: Low-dose acetylsalicylic acid and bleeding risks with ventriculoperitoneal shunt placement.
abstract: OBJECTIVE Ventriculoperitoneal (VP) shunt placement is a common procedure for the treatment of hydrocephalus following diverse neurosurgical conditions. Most of the patients present with other comorbidities and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite its clinical relevance, the perioperative management of these patients has not been sufficiently investigated. The aim of this study was to compare the peri- and postoperative bleeding complication rates associated with ASA intake in patients undergoing VP shunt placement. METHODS Of 172 consecutive patients undergoing VP shunt placement between June 2009 and December 2015, 40 (23.3%) patients were receiving low-dose ASA treatment. The primary outcome measure was bleeding events in ASA users versus nonusers, whereas secondary outcome measures were postoperative cardiovascular events, hematological findings, morbidity, and mortality. A subgroup analysis was conducted in patients who discontinued ASA treatment for < 7 days (n = 4, ASA Group 1) and for ≥ 7 days (n = 36, ASA Group 2). RESULTS No statistically significant difference for bleeding events was observed between ASA users and nonusers (p = 0.30). Cardiovascular complications, surgical morbidity, and mortality did not differ significantly between the groups either. Moreover, there was no association between ASA discontinuation regimens (< 7 days and ≥ 7 days) and hemorrhagic events. CONCLUSIONS Given the lack of guidelines regarding perioperative management of neurosurgical patients with antiplatelet therapy, these findings elucidate one issue, showing comparable bleeding rates in ASA users and nonusers undergoing VP shunt placement.
authors: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors: Maria
authors: M
authors: Kamenova
authors: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors: Davide
authors: D
authors: Croci
authors: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors: Raphael
authors: R
authors: Guzman
authors: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors: Luigi
authors: L
authors: Mariani
authors: Department of Neurosurgery, University Hospital of Basel, Switzerland.
authors: Jehuda
authors: J
authors: Soleman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000639:trends
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: ASA = acetylsalicylic acid; CAD = coronary artery disease; Hb = hemoglobin; LMWH = low-molecular-weight heparin; NPH = normal-pressure hydrocephalus; PBC = packed blood cells; Tc = thrombocyte; VP = ventriculoperitoneal; aSAH = aneurysmal subarachnoid hemorrhage; acetylsalicylic acid; antithrombotic therapy; bleeding events; cSDH = chronic subdural hematoma; ventriculoperitoneal shunt