Comparison of blood loss according to use of aspirin in lumbar fusion patients.

OBJECTIVE

To investigate and compare blood losses intra and postoperatively between lumbar fusion patients with and without antiplatelet use.

METHODS

A total of 106 patients who had undergone at least 2 or more segments of lumbar fusion surgery were selected for the study. They were divided into three groups. Group 1 was not on medication before the surgery. Groups 2 and 3 had taken aspirin prior to the surgery. Group 2 discontinued the medication 1 week before the operation, but group 3 continued the use. In addition, non-steroid anti-inflammatory drug (NSAIDs) use in all patients was questioned. Amount of blood losses and platelet function were evaluated.

RESULTS

When usage of NSAID was not controlled, intraoperative, postoperative, and total blood losses were found to have no statistical significance among the groups. However, when NSAID usage was taken into account, there were significantly higher blood losses in groups 2 and 3 compared with group 1. The use of NSAID resulted in significantly higher blood loss in group 1, but not in groups 2 or 3. The platelet function test results disclosed statistical differences between groups 1 and 2 and groups 1 and 3.

CONCLUSION

Aspirin significantly increases the risk of bleeding in patients undergoing lumbar fusion at two or more levels. This risk is present even in patients who discontinued aspirin 1 week prior to surgery. In patients with high risk of complications resulting from aspirin discontinuation, the use should be allowed in lumbar fusion surgery. However, strong attention must be paid to avoid excessive bleeding. Because NSAID use also increases surgical blood loss, proper interval from discontinuation to surgery must be granted to minimize the risk.