Aspin: neurosurgical aspirin intervention prognostic study - perioperative continuation versus discontinuation of...

Area of Science:

• Neurosurgery
• Cardiology
• Hematology

Background:

• Aspirin is often stopped before spinal surgery due to bleeding risks.
• Stopping aspirin may increase perioperative cardiac and neurological thrombotic events.
• Evidence is lacking to guide aspirin management in spinal surgery.

Purpose of the Study:

• To evaluate the non-inferiority of continuing aspirin versus discontinuing it.
• Focus on patients undergoing low complexity lumbar spinal surgery.
• Compare bleeding and thrombotic complication rates.

Main Methods:

• Randomized controlled trial with 554 patients.
• Two parallel groups: aspirin continuation vs. discontinuation.
• Patients undergoing low complexity lumbar spinal surgery, aged over 18, on aspirin.

Main Results:

• Primary outcome: composite bleeding complications (neurological deterioration, anemia, hematoma, major/minor hemorrhage).
• Secondary outcomes: operative blood loss, thromboembolic events (myocardial infarction, stroke, VTE).
• Patient-reported outcomes: anticoagulant satisfaction and general health.

Conclusions:

• Perioperative aspirin continuation is non-inferior to discontinuation for low complexity lumbar spinal surgery.
• This approach balances bleeding risks with the prevention of thrombotic events.
• Provides evidence to potentially revise current clinical practice regarding aspirin management.