Aspin: neurosurgical aspirin intervention prognostic study - perioperative continuation versus discontinuation of aspirin in lumbar spinal surgery, a randomized controlled, noninferiority trial

• Published in: Current controlled trials in cardiovascular medicine Vol. 25; no. 1; p. 156
• Main Authors: Zian, Ahmed, Overdevest, Gijsbert M, Schutte, Pieter J, Klok, Frederikus A, Steyerberg, Ewout W, Moojen, Wouter A, van der Gaag, Niels A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.02.2024; BioMed Central; BMC
• Subjects: Anemia; Aneurysms; Anticoagulants; Anticoagulants - therapeutic use; Aspirin; Aspirin - adverse effects; Back surgery; Blood Loss, Surgical - prevention & control; Blood transfusions; Brain surgery; Cardiovascular disease; Comparative analysis; Dosage and administration; Drug dosages; Epidural; Heart attacks; Hematoma; Hemoglobin; Hemorrhage; Hospitals; Humans; Hypotheses; Information systems; Intervention; Medical prognosis; Methods; Mortality; Neurosurgical Procedures; Outpatient care facilities; Pain; Patients; Perioperative care; Platelet Aggregation Inhibitors - adverse effects; Prognosis; Randomized Controlled Trials as Topic; Safety and security measures; Spine; Stroke; Surgery; Thromboembolism; Thrombosis; Netherlands
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-024-07945-w

Aspirin is typically discontinued in cranial and spinal surgery because of the increased risk of hemorrhagic complications, but comes together with the risk of resulting in an increase of cardiac and neurologic thrombotic perioperative events. The aim of this study is to investigate the non-inferiority of perioperative continuation of aspirin patients undergoing low complex lumbar spinal surgery, compared with the current policy of perioperative discontinuation of aspirin. A randomized controlled trial with two parallel groups of 277 cases (554 in total). Patients undergoing low complex lumbar spinal surgery and using aspirin. All patients are aged >18 years. Peri-operative continuation of aspirin. Primary study outcome: composite of the following bleeding complications: Neurological deterioration as a result of hemorrhage in the surgical area with cauda and/or nerve root compression. Post-surgical anemia with hemoglobin level lower than 5 mmol/l, requiring transfusion. Subcutaneous hematoma leading to wound leakage and pain higher than NRS=7. Major and/or minor hemorrhage in any other body system according to the definition of the International Society on Thrombosis and Haemostasis bleeding scale. Secondary study outcomes: Each of the individual components of the primary outcome Absolute mean difference in operative blood loss between the study arms Thrombo-embolic-related complications: Myocardial infarction Venous thromboembolism Stroke Arterial thromboembolism FURTHER STUDY OUTCOMES: Anticoagulant treatment satisfaction by the Anti-Clot Treatment Scale (ACTS) and general health by the Patient-Reported Outcomes Measurement Information System (PROMIS Global-10) in the pre- and postoperative phase. NATURE AND EXTENT OF THE BURDEN AND RISKS ASSOCIATED WITH PARTICIPATION, BENEFIT, AND GROUP RELATEDNESS: Participation in this study imposes no additional risk to patients. Currently, there is no consensus on whether or not aspirin should be discontinued before cranial or spinal surgery. Currently, aspirin is typically discontinued in cranial and spinal surgery, because of a potential increased risk of hemorrhagic complication. An argument not based on a clinical trial. However, this policy might delay surgical procedures or carry the risk of resulting in an increase in cardiac and neurologic thrombotic perioperative events. It is unclear if the possibility of an increase in hemorrhage-related complications outweighs the risk of an increase in cardiac and neurologic thrombotic perioperative events. Furthermore, the Data Safety Monitoring Board (DSMB) will be asked for safety analysis by monitoring the study. There are no further disadvantages to participating in this study. Outcome measurements are recorded during admission and regular outpatient visits, and thus, do not require additional visits to the hospital.