A randomized trial in Switzerland found that ceasing low-dose aspirin for 12 days during surgery for chronic subdural hematoma may not reduce the risk of recurrence.
Researchers enrolled 155 adult patients who were already taking aspirin prior to developing chronic subdural hematoma (cSDH). The participants underwent burr hole drainage and were randomized to either continue aspirin therapy or receive a placebo for 12 days during the perioperative period. The researchers followed participants for 6 months to monitor for hematoma recurrence and cardiovascular events.
Recurrence requiring reoperation occurred in 13.9% of the aspirin group and 9.5% of the placebo group. The difference wasn't statistically significant (risk difference = 4.4%;, 95% confidence interval = −7.2% to 15.9%, P = .56).
The incidence of cardiovascular or thromboembolic events was similar between the groups (0.27 events per person half-year in the aspirin group vs 0.28 in the placebo group). Cardiovascular events that could indicate a need for aspirin therapy were reported in 1 participant in the aspirin group and 4 in the placebo group.
Four participants in the aspirin group and 2 in the placebo group died during the study period, but none of the deaths were attributed to bleeding. Minor intracranial bleeding events unrelated to hematoma recurrence occurred in 6 aspirin-treated participants and 5 in the placebo group. Two of these events in each group led to reoperation but didn't affect clinical outcomes or result in mortality.
Baseline characteristics were similar between the groups. The mean patient age was 78 years, and most were male. Common presenting symptoms included ataxia and motor deficits. Approximately 93% of the participants underwent surgery within 24 hours of admission.
At 6 months, favorable outcomes—defined as a modified Rankin Scale score of 0 to 2—were observed in 89.1% of the patients in the aspirin group and 86.7% in the placebo group.
The researchers noted that previous observational studies had reported higher recurrence rates—up to 33%—among patients who continued aspirin therapy. The current trial, however, observed lower rates overall.
“The SECA randomized clinical trial suggests that discontinuing [aspirin] treatment did not reduce the recurrence rate of surgically treated cSDH within 6 months,” said lead study author Maria Kamenova, MD, of the Department of Neurosurgery at the University Hospital of Basel in Switzerland, and her colleagues.
The study, conducted at six centers, was among the first randomized trials to examine aspirin continuation in this patient population. Limitations included a smaller-than-expected number of recurrence events and limited statistical power for subgroup analysis.
The researchers concluded that short-term aspirin discontinuation didn't confer significant benefit in reducing recurrence risk following cSDH surgery. They emphasized the need for larger trials to determine whether these findings apply across broader surgical and patient populations.
Full disclosures and funding sources are available in the original publication.
Source: JAMA Neurology
