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Acetylsalicylic acid (ASA) irreversibly blocks the platelet cyclo-oxygenase enzyme system, preventing formation of thromboxane A2 and inhibiting platelet aggregation for the life of the affected platelet (approximately 10 days).

This block occurs even at the lowest therapeutic/prophylactic ASA dose usually prescribed, 81 mg/day (10%/24 h). Because the ASA effect on individual platelets is complete, it cannot be reversed.

Based upon the customary rate of platelet production, approximately 5–6 days are required after cessation of ASA to replace approximately 50% of the circulating platelets

Aspirin is increasingly prescribed for its antithrombotic properties and usually recommended indefinitely following stent placement to prevent stent thrombosis.

Perioperative low dose use was not associated with increased risk of perioperative complications 1).

Aspirin increased the risk of rehaemorrhagia after surgery of hypertensive cerebral hemorrhage (HCH) 2).

Preinjury use of warfarin, but not antiplatelet medications, influences survival and need for neurosurgical intervention in elderly TBI patients with intracranial hemorrhage; hemorrhage progression and morbidity are not affected. The importance of antithrombotic therapy may lie in its impact on initial injury severity 3).

Counteracting aspirin

Various medicamentous methods of counteracting aspirin-induced platelet dysfunction and excessive bleeding in this context are revaluated. In this context, platelet infusion and the administration of Desmopressin seems to be an effective and accepted as well as frequently adopted measure to antagonize the aspirin effect on platelet function during various major surgical procedures 4)

Intracranial surgery

Rahman M, Donnangelo LL, Neal D, Mogali K, Decker M, Ahmed MM. Effects of perioperative acetyl salicylic acid (ASA) on clinical outcomes in patients undergoing craniotomy for brain tumor. World Neurosurg. 2015 Feb 26. pii: S1878-8750(15)00122-9. doi: 10.1016/j.wneu.2015.02.016. [Epub ahead of print] PubMed PMID: 25727304.
Chen T, Xu G, Tan D, Wu C. Effects of platelet infusion, anticoagulant and other risk factors on the rehaemorrhagia after surgery of hypertensive cerebral hemorrhage. Eur Rev Med Pharmacol Sci. 2015 Mar;19(5):795-9. PubMed PMID: 25807432.
Grandhi R, Harrison G, Voronovich Z, Bauer J, Chen SH, Nicholas D, Alarcon LH, Okonkwo DO. Preinjury warfarin, but not antiplatelet medications, increases mortality in elderly traumatic brain injury patients. J Trauma Acute Care Surg. 2015 Mar;78(3):614-21. doi: 10.1097/TA.0000000000000542. PubMed PMID: 25710435.
Korinth MC, Gilsbach JM, Weinzierl MR. Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany. Eur Spine J. 2007 Mar;16(3):365-72. Epub 2006 Sep 5. PubMed PMID: 16953446; PubMed Central PMCID: PMC2200713.
aspirin.txt · Last modified: 2016/09/05 22:38 (external edit)