Perioperative Aspirin Discontinuation May Not Reduce cSDH Recurrence
Discontinuing low-dose acetylsalicylic acid (ASA), commonly known as Aspirin, during the perioperative phase of surgical treatment of chronic subdural hematoma (cSDH) did not appear to reduce the recurrence rate of cSDH requiring reoperation over the next 6 months, according to results from a randomized clinical trial published in JAMA Neurology.
However, “[r]ecurrence risk estimates for continuous ASA treatment in this trial were distinctly lower than previously reported,” wrote first author Maria Kamenova, MD, of University Hospital of Basel, Basel, Switzerland, and study coauthors.
The SECA (Surgical Evacuation of Chronic Subdural Hematoma and Aspirin) trial investigated the efficacy and safety of temporarily discontinuing ASA around the time of cSDH surgery in 155 adult patients at 6 neurosurgical centers in Switzerland. Researchers were interested in both the risk of recurrence of cSDH, which was the trial’s main outcome, and the risk of cardiovascular events with continuous, compared with discontinuous, ASA treatment.
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Among the participants, 78 were randomized to continue ongoing ASA treatment and 77 were randomized to switch to placebo for 12 days during the perioperative phase of burr hole drainage surgery for cSDH. The study comprised 16.1% female patients, with a mean age of 77.9 years in the ASA group and 77.6 years in the placebo group.
According to the results, rates of cSDH recurrence requiring reoperation within 6 months were 13.9% for the ASA group and 9.5% for the placebo group, indicating no statistical difference.
Per person half-year, the incidence of any cardiovascular or thromboembolic event was 0.27 in the ASA group and 0.28 in the placebo group, the incidence of a cardiovascular event indicating ASA treatment was 0.02 in the ASA group and 0.06 in the placebo group, and the incidence of other bleeding events was 0.10 in the ASA group and 0.08 in the placebo group, secondary analyses found.
“All-cause mortality,” researchers reported, “occurred at an incidence of 0.06 per person half-year in the ASA group and 0.03 in the placebo group.”
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