Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands.
Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands; Cushing Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, 60 Fenwood Road, 1st Floor, Boston, MA, USA.
Spine J. 2017 Dec;17(12):1939-1946. doi: 10.1016/j.spinee.2017.08.238. Epub 2017 Aug 17.
Aspirin is typically discontinued in spinal surgery because of increased risk of hemorrhagic complications. The risk of perioperative continuation of aspirin in neurosurgery needed to be evaluated.
This study aimed to evaluate all available evidence about continuation of aspirin and to compare peri- and postoperative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin perioperatively in spinal surgery.
Systematic review and meta-analysis were carried out.
A meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or non-spinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection [SSI]), stroke, myocardial infarction within 30 days postoperatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I-squared [I]) and effect modification (P-interaction) assessment.
Out of 1,339 studies, three case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean=201.8 minutes, 95% confidence interval [CI]=193.3; 210.3; I=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95% CI=119.1; 237.6; I=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean perioperative blood loss were seen between the aspirin-continuing group (mean=553.9 milliliters, 95% CI=468.0; 639.9; I=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 milliliters, 95% CI=427.6; 649.8; I=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the two groups were found for cardiac events, stroke, and surgical site infections.
This meta-analysis showed an absence of significant differences in perioperative complications between aspirin continuation and discontinuation. Because of the paucity of included studies, further well-designed prospective trials are imperative to demonstrate potential benefit and safety.
由于出血并发症风险增加，通常会在脊柱手术中停用阿司匹林。需要评估神经外科围手术期继续使用阿司匹林的风险。
本研究旨在评估所有关于继续使用阿司匹林的证据，并比较在脊柱手术中继续使用阿司匹林和围手术期停用阿司匹林的患者的围手术期失血和并发症发生率。
系统评价和荟萃分析。
根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行荟萃分析。纳入比较阿司匹林继续使用与停用的研究。排除使用抗凝药物组合或非脊柱手术的研究。提取手术结果（失血量和手术时间）和不同并发症（手术部位感染 [SSI]）、术后 30 天内的中风、心肌梗死）。使用固定效应模型计算报告结果的总体患病率和平均值，并评估异质性（I 平方 [I]）和效应修饰（P 交互）。
在 1339 项研究中，有三项病例系列研究被纳入荟萃分析。在阿司匹林继续组（平均 201.8 分钟，95%置信区间 [CI]=193.3；210.3；I=95.4%；170 例）和阿司匹林停药组（平均 178.4 分钟，95% CI=119.1；237.6；I=93.5%；200 例）之间，手术时间的平均值无显著差异（P 交互=0.78）。在阿司匹林继续组（平均失血量 553.9 毫升，95% CI=468.0；639.9；I=83.4%；170 例）和阿司匹林停药组（平均失血量 538.7 毫升，95% CI=427.6；649.8；I=985.5%；200 例）之间，围手术期失血量的平均值无显著差异（P 交互=0.96）。两组之间在心脏事件、中风和手术部位感染方面也存在类似的无显著差异。
本荟萃分析显示，阿司匹林继续使用与停用在围手术期并发症方面无显著差异。由于纳入研究较少，需要进一步进行精心设计的前瞻性试验，以证明潜在的益处和安全性。
