Perioperative Management of Patients on Chronic Aspirin Therapy for Elective Brain Surgery: A Delphi Study.

IF 2.3 2区 医学 Q2 ANESTHESIOLOGY
Shaun E Gruenbaum, Alexander Kulikov, Ilana Logvinov, Ivana Erac, Philip M Jones, Federico Bilotta
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引用次数: 0

Abstract

Background: The perioperative management of chronic aspirin therapy in patients undergoing elective brain surgery is challenging due to the risk of bleeding and thromboembolic events. Although aspirin discontinuation reduces the bleeding risk, it can increase thrombotic complications, particularly in patients at high risk of cardiovascular complications. This Delphi study aimed to develop consensus-based guidelines to address these clinical challenges.

Methods: A 2-round Delphi survey was conducted among an international panel of 42 experienced anesthesiologists and neurosurgeons. Participants assessed the risks and benefits of perioperative aspirin management, including bleeding risk, thrombotic risk, timing of cessation and resumption, and the utility of platelet function testing. Consensus was defined as ≥80% agreement in round 2.

Results: Round 1 highlighted significant variability in practice patterns. In round 2, consensus was reached on several key areas. Most experts (84%) agreed that continuing aspirin increases perioperative bleeding risk in high-risk procedures, with 87% recommending discontinuing aspirin 5 to 7 days before surgery. Nearly all experts (97%) supported continuing low-dose aspirin in high-thrombotic-risk patients. Conversely, for low-thrombotic-risk patients, only 65% agreed on aspirin continuation, reflecting an ongoing debate. No consensus was reached regarding routine platelet function testing.

Conclusions: This Delphi study provides experience-based recommendations for managing chronic aspirin therapy in neurosurgical patients. The panel strongly supports aspirin continuation in high-thrombotic-risk patients, with cessation 5 to 7 days before high-bleeding-risk surgeries. Individualized management is advised for low-bleeding-risk procedures and low-thrombotic-risk patients. Future research should further clarify aspirin management in these groups and explore the role of platelet function testing in neurosurgical settings.

择期脑外科慢性阿司匹林治疗患者围手术期管理:一项德尔菲研究。
背景:由于出血和血栓栓塞事件的风险,择期脑外科患者慢性阿司匹林治疗的围手术期管理具有挑战性。尽管停用阿司匹林可降低出血风险,但它可增加血栓性并发症,特别是心血管并发症高危患者。本德尔菲研究旨在制定基于共识的指导方针,以应对这些临床挑战。方法:对42名经验丰富的国际麻醉师和神经外科医生进行2轮德尔菲调查。参与者评估围手术期阿司匹林治疗的风险和益处,包括出血风险、血栓形成风险、停止和恢复的时间以及血小板功能检测的效用。共识定义为在第2轮中达成≥80%的共识。结果:第一轮强调了实践模式的显著可变性。在第二轮谈判中,各方就几个关键领域达成了共识。大多数专家(84%)同意继续服用阿司匹林会增加高危手术围手术期出血风险,87%的专家建议在手术前5至7天停止服用阿司匹林。几乎所有的专家(97%)都支持高血栓风险患者继续服用低剂量阿司匹林。相反,对于低血栓风险患者,只有65%的人同意继续服用阿司匹林,这反映了一个正在进行的争论。关于常规血小板功能检测没有达成共识。结论:该德尔菲研究为神经外科患者的慢性阿司匹林治疗提供了基于经验的建议。专家组强烈支持高危血栓患者继续服用阿司匹林,在高危出血手术前5 - 7天停用阿司匹林。建议对低出血风险手术和低血栓风险患者进行个体化治疗。未来的研究应进一步明确阿司匹林在这些组中的管理,并探讨血小板功能检测在神经外科环境中的作用。
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来源期刊
CiteScore
6.20
自引率
10.80%
发文量
119
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.
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