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Published on: August 30, 2020
Association between aspirin dose and subarachnoid hemorrhage from saccular aneurysms: A case-control study
Anil Can1, Robert F Rudy1, Victor M Castro1
1From the Department of Neurosurgery (A.C., R.F.R., R.D.), Brigham and Women's Hospital, Harvard Medical School; Research Information Systems and Computing (V.M.C., V.G., S.M.); Department of Medicine (S.Y., S.T.W.), Division of Rheumatology, Immunology and Allergy (N.A.S.), and Channing Division of Network Medicine (S.T.W., R.D.), Brigham and Women's Hospital, Boston, MA; Center for Statistical Science (S.Y.), Tsinghua University, Beijing, China; Boston Children's Hospital Informatics Program (D.D., S.F., G.S.), MA; Department of Computer Science (D.D.), Loyola University, Chicago, IL; Department of Neurology (S.M.), Massachusetts General Hospital; and Biostatistics (T.C.), Harvard T.H. Chan School of Public Health, Boston, MA.
Insights
Aspirin use may decrease the risk of ruptured intracranial aneurysms, showing a dose-response relationship. However, aspirin increases the risk of rerupture after an aneurysm has occurred.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Intracranial aneurysms are a significant cause of morbidity and mortality.
- Aspirin is widely used for cardiovascular prevention, but its role in aneurysm management is unclear.
- Understanding aspirin's effects on aneurysm rupture and rerupture is crucial for patient care.
Purpose of the Study:
- To investigate the association between aspirin use and aspirin dosage with the risk of ruptured saccular intracranial aneurysms.
- To evaluate the impact of aspirin on the risk of aneurysm rerupture before treatment.
Main Methods:
- A large case-control study involving 4,701 patients with 6,411 intracranial aneurysms.
- Multivariable logistic regression and propensity score weighting were used to analyze the association between aspirin use and aneurysm rupture.
- Additional analyses examined aspirin's effect on rerupture risk.
Main Results:
- Aspirin use was significantly associated with a decreased risk of ruptured intracranial aneurysms (OR 0.60).
- An inverse dose-response relationship was observed between aspirin dose and aneurysmal subarachnoid hemorrhage.
- Aspirin use was linked to an increased risk of rerupture before treatment (OR 8.15).
Conclusions:
- Aspirin therapy at diagnosis is associated with a reduced risk of subarachnoid hemorrhage, with a dose-dependent effect.
- Once an aneurysm ruptures, aspirin use is associated with a higher risk of rerupture prior to intervention.
Objective:
To determine the association between ruptured saccular aneurysms and aspirin use/aspirin dose.
Methods:
Four thousand seven hundred one patients who were diagnosed at the Massachusetts General Hospital and Brigham and Women's Hospital between 1990 and 2016 with 6,411 unruptured and ruptured saccular intracranial aneurysms were evaluated. Univariable and multivariable logistic regression analyses were performed to determine the association between aneurysmal subarachnoid hemorrhage and aspirin use, including aspirin dose. Inverse probability weighting using propensity scores was used to adjust for potential differences in baseline characteristics between cases and controls. Additional analyses were performed to examine the association of aspirin use and rerupture before treatment.
Results:
In multivariate analysis with propensity score weighting, aspirin use (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.45-0.80) was significantly associated with decreased risk of ruptured intracranial aneurysms. There was a significant inverse dose-response relationship between aspirin dose and aneurysmal subarachnoid hemorrhage (OR 0.65, 95% CI 0.53-0.81). In contrast, there was a significant association between aspirin use and increased risk of rerupture before treatment (OR 8.15, 95% CI 2.22-30.0).
Conclusions:
In this large case-control study, aspirin therapy at diagnosis was associated with a significantly decreased risk of subarachnoid hemorrhage, with an inverse dose-response relationship among aspirin users. However, once rupture has occurred, aspirin is associated with an increased risk of rerupture before treatment.
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