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

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Ventriculoperitoneal (VP) shunt placement is a common procedure for the treatment of hydrocephalus following diverse neurosurgical conditions. Most of the patients present with other comorbidities and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite its clinical relevance, the perioperative management of these patients has not been sufficiently investigated. The aim of this study was to compare the peri- and postoperative bleeding complication rates associated with ASA intake in patients undergoing VP shunt placement.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Of 172 consecutive patients undergoing VP shunt placement between June 2009 and December 2015, 40 (23.3%) patients were receiving low-dose ASA treatment. The primary outcome measure was bleeding events in ASA users versus nonusers, whereas secondary outcome measures were postoperative cardiovascular events, hematological findings, morbidity, and mortality. A subgroup analysis was conducted in patients who discontinued ASA treatment for &lt; 7 days (n = 4, ASA Group 1) and for ≥ 7 days (n = 36, ASA Group 2).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>No statistically significant difference for bleeding events was observed between ASA users and nonusers (p = 0.30). Cardiovascular complications, surgical morbidity, and mortality did not differ significantly between the groups either. Moreover, there was no association between ASA discontinuation regimens (&lt; 7 days and ≥ 7 days) and hemorrhagic events.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Given the lack of guidelines regarding perioperative management of neurosurgical patients with antiplatelet therapy, these findings elucidate one issue, showing comparable bleeding rates in ASA users and nonusers undergoing VP shunt placement.</jats:p></jats:sec>

Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis

“…The hemorrhage rate in patients receiving DAPT (22%) is higher than the 0%-8.3% rate of VP shunt-associated hemorrhage reported in the neurosurgical literature. 9,12 Only one of these hemorrhages was clinically significant, requiring shunt revision, although the patient did not suffer permanent morbidity. These data confirm that continuation of DAPT for prevention of in-stent thrombosis is safe and thus important during placement of VP shunts for persistent hydrocephalus in aSAH patients.…”

Effect of preoperative antiplatelet or anticoagulation therapy on hemorrhagic complications in patients with traumatic brain injury undergoing craniotomy or craniectomy

“…24,27 Early ASA resumption or even continued perioperative intake was shown to be safe for burr-hole drainage in chronic subdural hematoma (cSDH) as well as shunt placement. 9,10,14,15,17 To our knowledge, there are no randomized controlled trials (RCTs) analyzing bleeding risk with continued perioperative AP/AC treatment in neurosurgery. A protocol for an ongoing RCT of continued ASA treatment for patients undergoing surgical evacuation of cSDH has been published and the study is currently ongoing.…”

Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement

“…Ventriculoperitoneal (VP) shunt placement is a standard procedure for the treatment of hydrocephalus for various conditions like normal pressure hydrocephalus (NPH), intracranial hemorrhage, aneurysmal subarachnoid hemorrhage (aSAH), meningitis, tumor, or trauma [ 1 , 2 , 3 , 4 , 5 , 6 ]. Despite being widely used, VP shunting is still plagued with complications that develop in 20 to 40% of the patients [ 7 , 8 , 9 , 10 ].…”