Neurointervention.  2021 Jul;16(2):141-148. 10.5469/neuroint.2021.00150.

Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

• Evans D
• Flood R
• Davies O
• Wareham J
• Mortimer A

• KMID: 2517739
• DOI: http://doi.org/10.5469/neuroint.2021.00150

Abstract

Purpose
Aspirin has beneficial effects on coiling, even in acute subarachnoid hemorrhage, but there is also a perceived risk of increased bleeding and, importantly, a concern regarding ventriculostomy-associated hemorrhage (VAH) in those with complicating hydrocephalus. We aimed to assess the rate and extent of VAH in patients specifically treated with procedural intravenous aspirin during endovascular coiling of ruptured intracranial aneurysms.
Materials and Methods
This was a single neurovascular center retrospective observational study of consecutive patients treated over a three-year period. The rate of VAH assessed using computed tomography and clinical outcomes were compared in patients receiving intraprocedural intravenous aspirin loading (n=90) versus those that did not receive the drug (n=40).
Results
There was a significantly elevated rate of VAH in patients receiving intravenous aspirin (30% vs. 2.5%, odds ratio 16.7 [95% confidence interval: 2.2–128.0], P<0.0001). The majority of VAH was <10 mm in size (70%) with the largest bleed measuring 20 mm. No hematoma required surgical evacuation. No difference in favorable outcome at discharge was demonstrated. There was no difference in mortality between the 2 groups.
Conclusion
Loading with intravenous aspirin during endovascular treatment of ruptured intracranial aneurysms significantly increases the risk of VAH, but most are small with minimal impact on clinical outcome at discharge. Intravenous aspirin should probably be reserved for selected cases but should not be withheld based on risk of VAH.

Keyword

Aneurysm; Aspirin; External ventricular drain; Ventriculostomy; Antiplatelet; Subarachnoid haemorrhage

Figure

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  Fig. 1. Characteristic ventriculostomy-associated hemorrhage (VAH). (A) A typical <1 cm hematoma that accounted for the vast majority of VAH. (B) A 13 mm hematoma typical of the larger bleeds seen in the study. (C) The largest hematoma encountered in this study measuring 20 mm in the longest dimension.

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  Fig. 2. Summary of patient selection.

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