Perioperative continuation of aspirin was associated with a higher rate of 48-hour acute postoperative hemorrhagic events after burr-hole craniotomy for cSDH, while no advantage of pause >5 days over ≤5 days was detected.
Key Findings
Results
Perioperative aspirin continuation was associated with significantly higher rates of acute postoperative hemorrhagic events within 48 hours compared to any discontinuation.
4/19 (21.1%) hemorrhagic events in the continuation group versus 2/85 (2.4%) in the combined discontinuation groups
Fisher p = 0.010; unadjusted OR 9.70, 95% CI 1.88–49.91
Adjusted OR 11.58, 95% CI 1.40–95.39, p = 0.023, after controlling for age, Charlson Comorbidity Index, baseline mRS, desmopressin, and prophylactic indication
Among 104 patients with 1-month follow-up data, 6 total acute hemorrhagic events (5.8%) occurred across all groups
Three-group comparison (continuation vs. short pause vs. long pause: 21.1% vs. 0% vs. 4.4%) was also statistically significant (p = 0.005)
Results
No significant difference in hemorrhagic event rates was detected between short-pause (≤5 days) and long-pause (>5 days) aspirin discontinuation groups.
Short pause group had 0/40 (0%) hemorrhagic events versus long pause group with 2/45 (4.4%)
The study found 'no advantage of pause >5 days over ≤5 days'
Short pause group n = 47 and long pause group n = 69 in the full cohort of 140 patients
This finding suggests that brief discontinuation may be sufficient to reduce hemorrhagic risk without requiring extended pre-operative aspirin withdrawal
Results
Thromboembolic events were rare and not significantly associated with aspirin discontinuation status.
Only one thromboembolic event (1.0%) occurred, and it was in the continuation group
No statistically significant association between aspirin management strategy and thromboembolic events was found
Follow-up for thromboembolic events was reported within 1 month postoperatively
The rarity of thromboembolic events limited statistical power to assess this outcome
Results
Functional outcomes at 1 month and 6 months favored aspirin discontinuation over continuation.
Glasgow Outcome Scale (GOS) at 1 month differed significantly across groups (p = 0.004)
Modified Rankin Scale (mRS) at 6 months also differed significantly across groups (p = 0.004)
Both outcomes favored the discontinuation groups over the continuation group
GOS was assessed at discharge and 1 month; mRS was assessed at 6 months
Results
Length of stay, 3-month recurrence, reoperation rates, and 1-month mortality did not differ significantly among aspirin management groups.
3-month recurrence rate was 8/104 (7.7%) overall, with no significant difference between groups (p = 0.88)
LOS, reoperation, and 1-month mortality showed no statistically significant differences across continuation, short-pause, and long-pause groups
These null findings suggest that aspirin management strategy does not meaningfully affect medium-term recurrence or survival
Results
The continuation group received perioperative desmopressin at a significantly higher rate than the discontinuation groups, reflecting clinical practice adjustments.
Desmopressin use was 54.2% in the continuation group versus 8.5% in the short-pause group and 1.5% in the long-pause group (p < 0.001)
This was one of the few baseline characteristic imbalances among the three groups
Desmopressin was included as a covariate in the adjusted logistic regression model
A sensitivity analysis excluding desmopressin recipients (n = 88) showed a consistent direction of effect for hemorrhagic events (continuation 2/9, 22.2% vs. discontinuation 2/79, 2.5%; Fisher p = 0.05)
Methods
The study population consisted of 140 aspirin-treated adults with chronic subdural hematoma treated across four European centers.
All patients underwent burr-hole craniotomy plus subdural drain for cSDH
Groups: continuation n = 24, short pause (≤5 days) n = 47, long pause (>5 days) n = 69
104 patients had 1-month follow-up data available for primary endpoint analysis
Baseline characteristics were generally balanced except for desmopressin use
Design was a multicenter retrospective cohort study
What This Means
This research suggests that continuing aspirin right up until surgery for chronic subdural hematoma (a collection of blood on the brain's surface, common in older adults) is associated with a meaningfully higher risk of bleeding complications within the first 48 hours after the procedure. In this study of 140 patients across four European hospitals, about 1 in 5 patients who kept taking aspirin up to the time of surgery experienced an early postoperative bleed, compared to roughly 1 in 40 patients whose aspirin was stopped beforehand. Importantly, stopping aspirin for just a few days (5 days or fewer) appeared to be as protective as stopping it for longer periods, suggesting that a prolonged pre-surgical aspirin hold may not be necessary.
On the other side of the equation, blood clot-related complications (such as strokes or deep vein thrombosis) were very rare overall — only one such event occurred in the entire cohort — and were not significantly linked to whether aspirin was continued or stopped. Patients who had aspirin discontinued also had better functional outcomes at one month and six months after surgery. Rates of hematoma recurrence, need for repeat surgery, hospital length of stay, and one-month mortality were similar across all groups.
This research suggests that a brief pre-operative pause in aspirin therapy — rather than long-term discontinuation or continuation — may strike an appropriate balance between reducing surgical bleeding risk and minimizing thromboembolic risk. However, the authors caution that this was a retrospective, observational study with a relatively small sample size, and that prospective studies and meta-analyses are needed before definitive clinical guidelines can be established.
Carbone F, Leone A, Colangelo M, Squeo C, Fochi N, Rigotto L, et al.. (2026). Perioperative aspirin discontinuation prior to burr-hole drainage for chronic subdural hematoma: A European multicenter retrospective cohort study.. Clinical neurology and neurosurgery. https://doi.org/10.1016/j.clineuro.2026.109499