Available online 30 March 2013
Publication year: 2013
Source:World Neurosurgery
Objective Recent evidence has suggested a potential beneficial effect of aspirin on the risk of aneurysm rupture. This benefit must be weighed against its potential adverse effects as an anti-platelet agent in the setting of acute aneurysmal subarachnoid hemorrhage (SAH). Methods The authors reviewed a consecutive series of 747 patients with cerebral aneurysms, comparing demographics, aneurysm features, presenting clinical and radiographic grades, vasospasm and outcome at 1 year between patients with aneurysmal SAH taking aspirin on presentation and those who were not. Results The rate of hemorrhagic presentation was significantly greater in patients not taking aspirin (40% vs 28%, p = 0.016). Among 274 patients presenting with aneurysmal SAH, there was no significant difference in presenting clinical (Hunt-Hess) and radiographic (Fisher) grade between patients taking aspirin and those who were not. There was also no significant difference in the rate of subsequent angiographic and delayed cerebral ischemia (DCI). Multivariate analysis of outcome at 1 year found only increasing age (OR 1.19, 95% CI 0.35-4.09), Hunt-Hess (HH) grade (OR 3.01, 95% CI 1.81-5.03), and associated hypertension (OR 3.30, 95% CI 1.39-7.81) to be statistically significant risk factors for poor outcome (death or dependence), while aspirin use was not associated with poor outcome (OR 1.19, 95% CI 0.35-4.09, p = 0.78). Conclusion In this study, patients taking aspirin had a lower rate of hemorrhagic presentation. In addition, taking aspirin did not adversely impact presenting clinical grade or radiographic grade, vasospasm and outcome in the setting of aneurysmal SAH.
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