Background/Objectives: Patients with gliomas show an increased risk of spontaneous hemorrhages throughout the disease. Simultaneously, the number of patients taking acetylsalicylic acid (ASA) for primary and secondary prophylaxis is rising in daily clinical practice, and interrupting ASA intake before elective or emergency intracranial surgery is not always feasible. This study aims to evaluate the risks associated with continuing ASA use perioperatively while focusing on hemorrhage and potential thromboembolic events that may arise from discontinuing ASA, particularly in multimorbid patients undergoing glioma surgery. Methods: The clinical parameters and imaging data of 7149 patients who underwent intracranial surgery in our department over a 10-year period were retrospectively analyzed. Patients were categorized into two groups based on their ASA status: Group 1 (no ASA impact) included those with no ASA use or who discontinued ASA use more than seven days prior to surgery (low stroke or cardiovascular risk), and Group 2 (ASA impact) included those who continued ASA use within seven days prior to operation (high stroke or cardiovascular risk). Results: In this retrospective study, data from 650 patients with various types of glial tumors who underwent surgery between 2008 and 2018 were examined. Of these patients, 50 experienced a postoperative hemorrhage (POH), and 10 required reoperations due to clinical neurological deterioration and increased intracranial pressure caused by the space-occupying effect of the hemorrhage. In the ASA impact group, 2.7% developed POH, compared to 1.3% in the no ASA impact group (p= 0.098). Our analysis did not show a significantly increased risk of POH after surgery, although patients in the ASA impact group had a one- to two-fold higher risk of developing POH overall. Additionally, other factors contributing to postoperative hemorrhage following glioma surgery were investigated and evaluated. Conclusions: In this cohort, the perioperative use of ASA was not associated with an increased rate of hemorrhagic complications after intracranial glioma surgery, although a trend was observed. In patients with high stroke and cardiovascular risk, ASA can be continued during elective brain tumor surgery.
背景/目的：胶质瘤患者在病程中自发性出血风险增高。与此同时，临床实践中接受乙酰水杨酸（ASA）进行一级和二级预防的患者数量持续上升，而在择期或急诊颅内手术前中断ASA治疗并非总是可行。本研究旨在评估围手术期持续使用ASA的相关风险，重点关注停药可能引发的出血及潜在血栓栓塞事件，特别是在接受胶质瘤手术的多病共存患者中。方法：回顾性分析我科10年间7149例接受颅内手术患者的临床参数与影像学资料。根据ASA使用状态将患者分为两组：第1组（无ASA影响组）包括未使用ASA或术前7天以上停用ASA者（卒中或心血管风险较低）；第2组（ASA影响组）包括术前7天内持续使用ASA者（卒中或心血管风险较高）。结果：本回顾性研究分析了2008年至2018年间接受手术的650例各型胶质瘤患者数据。其中50例发生术后出血（POH），10例因血肿占位效应导致神经功能临床恶化及颅内压增高需再次手术。ASA影响组POH发生率为2.7%，无ASA影响组为1.3%（p=0.098）。分析显示虽然ASA影响组患者总体POH风险增加1-2倍，但术后POH风险无显著升高。此外，本研究还对胶质瘤术后出血的其他影响因素进行了探讨与评估。结论：在本队列研究中，围手术期使用ASA虽呈现风险升高趋势，但未显著增加颅内胶质瘤术后出血并发症发生率。对于高卒中及心血管风险患者，择期脑肿瘤手术期间可继续使用ASA。
肿瘤(癌症)患者之家