Introduction: Although data suggests that Aspirin usage may decrease the risk of rupture of cerebral aneurysms, any potential therapeutic benefits to Aspirin must be weighted against its antithrombotic properties and theoretical risk of greater hemorrhage if subarachnoid hemorrhage (SAH) occurs. This is the first nationwide analysis to evaluate the impact of Aspirin and antithrombotic usage on the outcomes of patients presenting with SAH.
Methods: Data from the Nationwide Inpatient Sample (2006-2010) were extracted. Patients with subarachnoid hemorrhage who underwent microsurgical or endovascular aneurysm repair were included. Multivariate logistic regression was performed to calculate the adjusted odds of in-hospital mortality; the development of a post-procedural complication; and of a non-routine discharge for patients with longterm Aspirin or antithrombotic medication usage. Multivariate linear regression evaluated length of hospital stay. Co-variates included patient age; gender; co-morbidities; ventriculostomy; mechanical ventilation; intraparenchymal hemorrhage; hospital bed size and teaching status.
Results: 9.974 hospital admissions were examined: longterm Aspirin use was coded in 1.6% (n=159) and anti-thrombotic use in 0.9% (n=85). Both Aspirin and antithrombotic users were significantly older and had a greater burden of comorbid disease (P<0.001). Neither in-hospital mortality nor complication rates differed significantly for Aspirin users. Length of hospital stay was found to be significantly shorter (10 days versus 12 days, by 10.18%, 95% CI: 2.76-17.60%, P=0.007) and the odds of a non-routine discharge lower (OR: 0.59, 95% CI: 0.38-0.93, P=0.02) for Aspirin users. Although in-hospital mortality rate was higher for those with anti-thrombotic medication usage (22.4% versus 13.0%), this difference was not significant in multivariate analyses (OR 1.45, 95% CI: 0.93-2.26, P=0.11).
Conclusions: In this nationwide study evaluating patients with SAH and underwent aneurysm repair, neither long-term Aspirin nor anti-thrombotic medication usage were associated with differential mortality. Aspirin users were found to have shorter hospital stay and lower rates of non-routine discharge.
Patient Care: This study adds to the body of literature assessing the role of Aspirin in the outcomes of patients with subarachnoid hemorrhage
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the differences in the baseline demographics of patient with SAH by antithrombotic medication usage and 2) appreciate the data on how periprocedural outcomes vary with Aspirin usage.