Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis

Publication date: Available online 17 August 2017
Source:The Spine Journal
Author(s): R. Goes, I.S. Muskens, T.R. Smith, R.A. Mekary, M.L.D. Broekman, W.A. Moojen
Background contextAspirin is typically discontinued in spinal surgery because of increased risk of haemorrhagic complications. The risk of peri-operative continuation of aspirin in neurosurgery needed to be evaluated.PurposeTo evaluate all available evidence about continuation of aspirin and to compare peri- and post-operative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin peri-operatively in spinal surgery.Study SettingSystematic review and meta-analysis.MethodA meta-analysis was conducted according to the 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 post-operatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I²) and effect modification (P-interaction) assessment.ResultsOut of 1339 studies, 3 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%CI=193.3; 210.3; I²=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95%CI=119.1; 237.6; I²=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean peri-operative blood loss were seen between the aspirin-continuing group (mean=553.9 millilitres, 95%CI=468.0; 639.9; I²=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 millilitres, 95%CI=427.6; 649.8; I²=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the 2 groups were found for cardiac events, stroke, and surgical site infections.ConclusionsThis meta-analysis showed an absence of significant differences in peri-operative complications between aspirin continuation and discontinuation. Due to the paucity of included studies, further well-designed prospective trials are imperative to demonstrate potential benefit and safety.



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