Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage

L. Gerard Toussaint, Jonathan A. Friedman, Eelco F M Wijdicks, David G. Piepgras, Mark A. Pichelmann, Jon I. McIver, Robyn L. McClelland, Douglas A. Nichols, Fredric B. Meyer, John L D Atkinson

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Object. Previous studies have indicated an increased incidence of death in patients with subarachnoid hemorrhage (SAH) who are currently receiving anticoagulation therapy. The significance of previous aspirin use in patients with SAH is unknown. The authors analyzed the effects of prior aspirin use on clinical course and outcomes following aneurysmal SAH. Methods. The medical records of 305 patients with angiogram-confirmed aneurysmal SAH who consecutively presented to our institution between 1990 and 1997 within 7 days of ictus were analyzed. Twenty-nine (9.5%) of these patients had a history of regular aspirin use before onset of the SAH. The Glasgow Outcome Scale (GOS) was used to measure patient outcome at the longest available follow up. Aspirin users were older on average than nonusers (59 years of age compared with 53 years; p = 0.018). The mean admission Hunt and Hess grades of patients with and without aspirin use were similar (2 compared with 2.3; p = 0.51). Two trends, which did not reach statistical significance, were observed. 1) The rebleeding rate in aspirin users was 14.3%, compared with a 4.7% rebleeding rate in nonusers (p = 0.06). 2) Permanent disability from vasospasm was less common among aspirin users (23% compared with 50%; p = 0.069). Outcomes did not differ between aspirin users and nonusers (mean GOS Score 3.83 compared with GOS Score 3.86, respectively; p = 0.82). Conclusions. Despite trends indicating increased rebleeding rates and a lower incidence of permanent disability due to delayed ischemic neurological deficits, there was no significant effect of previous aspirin use on overall outcome following aneurysmal SAH. Based on these preliminary data, the presence of an intracranial aneurysm is not a strict contraindication to aspirin use.

Original languageEnglish (US)
Pages (from-to)921-925
Number of pages5
JournalJournal of Neurosurgery
Volume101
Issue number6
DOIs
StatePublished - Dec 2004
Externally publishedYes

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Subarachnoid Hemorrhage
Aspirin
Glasgow Outcome Scale
Incidence
Intracranial Aneurysm
Medical Records
Angiography
Outcome Assessment (Health Care)

Keywords

  • Aspirin
  • Cerebral aneurysm
  • Rebleeding
  • Subarachnoid hemorrhage
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Toussaint, L. G., Friedman, J. A., Wijdicks, E. F. M., Piepgras, D. G., Pichelmann, M. A., McIver, J. I., ... Atkinson, J. L. D. (2004). Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery, 101(6), 921-925. https://doi.org/10.3171/jns.2004.101.6.0921

Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. / Toussaint, L. Gerard; Friedman, Jonathan A.; Wijdicks, Eelco F M; Piepgras, David G.; Pichelmann, Mark A.; McIver, Jon I.; McClelland, Robyn L.; Nichols, Douglas A.; Meyer, Fredric B.; Atkinson, John L D.

In: Journal of Neurosurgery, Vol. 101, No. 6, 12.2004, p. 921-925.

Research output: Contribution to journalArticle

Toussaint, LG, Friedman, JA, Wijdicks, EFM, Piepgras, DG, Pichelmann, MA, McIver, JI, McClelland, RL, Nichols, DA, Meyer, FB & Atkinson, JLD 2004, 'Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage', Journal of Neurosurgery, vol. 101, no. 6, pp. 921-925. https://doi.org/10.3171/jns.2004.101.6.0921
Toussaint LG, Friedman JA, Wijdicks EFM, Piepgras DG, Pichelmann MA, McIver JI et al. Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2004 Dec;101(6):921-925. https://doi.org/10.3171/jns.2004.101.6.0921
Toussaint, L. Gerard ; Friedman, Jonathan A. ; Wijdicks, Eelco F M ; Piepgras, David G. ; Pichelmann, Mark A. ; McIver, Jon I. ; McClelland, Robyn L. ; Nichols, Douglas A. ; Meyer, Fredric B. ; Atkinson, John L D. / Influence of aspirin on outcome following aneurysmal subarachnoid hemorrhage. In: Journal of Neurosurgery. 2004 ; Vol. 101, No. 6. pp. 921-925.
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abstract = "Object. Previous studies have indicated an increased incidence of death in patients with subarachnoid hemorrhage (SAH) who are currently receiving anticoagulation therapy. The significance of previous aspirin use in patients with SAH is unknown. The authors analyzed the effects of prior aspirin use on clinical course and outcomes following aneurysmal SAH. Methods. The medical records of 305 patients with angiogram-confirmed aneurysmal SAH who consecutively presented to our institution between 1990 and 1997 within 7 days of ictus were analyzed. Twenty-nine (9.5{\%}) of these patients had a history of regular aspirin use before onset of the SAH. The Glasgow Outcome Scale (GOS) was used to measure patient outcome at the longest available follow up. Aspirin users were older on average than nonusers (59 years of age compared with 53 years; p = 0.018). The mean admission Hunt and Hess grades of patients with and without aspirin use were similar (2 compared with 2.3; p = 0.51). Two trends, which did not reach statistical significance, were observed. 1) The rebleeding rate in aspirin users was 14.3{\%}, compared with a 4.7{\%} rebleeding rate in nonusers (p = 0.06). 2) Permanent disability from vasospasm was less common among aspirin users (23{\%} compared with 50{\%}; p = 0.069). Outcomes did not differ between aspirin users and nonusers (mean GOS Score 3.83 compared with GOS Score 3.86, respectively; p = 0.82). Conclusions. Despite trends indicating increased rebleeding rates and a lower incidence of permanent disability due to delayed ischemic neurological deficits, there was no significant effect of previous aspirin use on overall outcome following aneurysmal SAH. Based on these preliminary data, the presence of an intracranial aneurysm is not a strict contraindication to aspirin use.",
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AU - Pichelmann, Mark A.

AU - McIver, Jon I.

AU - McClelland, Robyn L.

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N2 - Object. Previous studies have indicated an increased incidence of death in patients with subarachnoid hemorrhage (SAH) who are currently receiving anticoagulation therapy. The significance of previous aspirin use in patients with SAH is unknown. The authors analyzed the effects of prior aspirin use on clinical course and outcomes following aneurysmal SAH. Methods. The medical records of 305 patients with angiogram-confirmed aneurysmal SAH who consecutively presented to our institution between 1990 and 1997 within 7 days of ictus were analyzed. Twenty-nine (9.5%) of these patients had a history of regular aspirin use before onset of the SAH. The Glasgow Outcome Scale (GOS) was used to measure patient outcome at the longest available follow up. Aspirin users were older on average than nonusers (59 years of age compared with 53 years; p = 0.018). The mean admission Hunt and Hess grades of patients with and without aspirin use were similar (2 compared with 2.3; p = 0.51). Two trends, which did not reach statistical significance, were observed. 1) The rebleeding rate in aspirin users was 14.3%, compared with a 4.7% rebleeding rate in nonusers (p = 0.06). 2) Permanent disability from vasospasm was less common among aspirin users (23% compared with 50%; p = 0.069). Outcomes did not differ between aspirin users and nonusers (mean GOS Score 3.83 compared with GOS Score 3.86, respectively; p = 0.82). Conclusions. Despite trends indicating increased rebleeding rates and a lower incidence of permanent disability due to delayed ischemic neurological deficits, there was no significant effect of previous aspirin use on overall outcome following aneurysmal SAH. Based on these preliminary data, the presence of an intracranial aneurysm is not a strict contraindication to aspirin use.

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KW - Rebleeding

KW - Subarachnoid hemorrhage

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