Aspirin is associated with an increased risk of subdural hematoma in normal-pressure hydrocephalus patients following shunt implantation

Abstract

obJect In this paper the authors investigate whether shunt-treated patients with normal-pressure hydrocephalus receiving aspirin therapy are at increased risk of developing subdural hematoma (SDH). Methods Records from 80 consecutive patients who had undergone implantation of a cerebrospinal fluid shunt for the treatment of normal-pressure hydrocephalus were retrospectively reviewed. results Eleven cases of symptomatic SDH occurred, all among patients receiving aspirin or clopidogrel. The 5-year survival estimate was 0.3 (p < 0.0001) for users of aspirin and the hazard ratio was 12.8 (95% CI 3.1-53). coNclusioNs Patients on an aspirin therapy regimen have a markedly increased risk of SDH after a shunt has been implanted for the treatment of normal-pressure hydrocephalus. Users of clopidogrel may have an even greater risk.

Acute subdural hematomas in shunted normal-pressure hydrocephalus patients – Management options and literature review: A case-based series

“…A recent report found a significantly increased rate of SDH among NPH patients who were using aspirin and underwent a VPS. [2] On the other hand, the chronic use of warfarin was found to be safe in a series of 15 NPH patients who underwent VPS insertion, as the rate of SDH was not higher than in other reports. [7]…”

“…[4914] Cerebrospinal fluid (CSF) shunting is considered a risk factor for subdural hematomas (SDH), which may develop among 2–17% of patients with CSF shunts. [2715] It is thought that the decrease in size of the drained ventricles results in stretching of bridging veins in the subdural space, making them prone for bleeding following even minor traumas. Additionally, a shunt can decrease the size of the ventricles, allowing more space for the developing hematoma while avoiding a potential “tamponade” effect, thus creating a more favorable milieu for bleeds to expand.…”

“…Factors that have been associated with SDH in VPS patients include the valve-type of the shunt system and the use of antiplatelet medications (APM) or anticoagulants. [2713] Lower valve settings predispose patients to overdrainage, increasing the risk for subdural hygromas and hematomas. [12] In addition, patients with higher lumbar opening pressures before shunt insertion were found to have increased risk for SDH, probably resulting from a relatively stronger tendency toward overdrainage.…”

Low-dose acetylsalicylic acid and bleeding risks with ventriculoperitoneal shunt placement

“…13 A study of patients with NPH who received ASA therapy and were treated with a VP shunt showed a significant increase of the occurrence of cSDH associated with antithrombotic therapy compared with nonusers. 2 Those authors proposed withholding ASA treatment 7 days prior to surgery and resuming it on the 1st-2nd postoperative day. However, it was shown that the antithrombotic effect of ASA vanishes in half of the patients after 72 hours and in 80% of the cases after 96 hours.…”

Neurosurgery in a patient on dual antiplatelet therapy. Case report and the review of the literature

“…Ликворошунтирующие операции и даже просто вентрикулостомия, которые, казалось бы, вполне можно отнести к хирургии «малого риска кровотечения», оказывается, тоже сопровождаются, согласно данным литературы [14,[30][31][32][33][34][35], достаточно высоким процентом геморрагических осложнений, в особенности на фоне проводимой ДАТ -ситуации, весьма похожей на описанную в нашем случае, а использование «мостиковой» терапии низкомолекулярными гепаринами или нефракционированным гепарином оказалось малоэффективным в профилактике тромбоза коронарного стента.…”