Effects of aspirin discontinuation on the risk of cardiovascular and cerebrovascular events and lower limb venousthrombosis and bleeding in the perioperative period of cervical surgery

doi:10.3969/j.issn.2095-4344.0244

Abstract

Abstract:

BACKGROUND: Traditional view holds that aspirin should be discontinued at least 5 to 7 days before spinal surgery to reduce the risk of intraoperative bleeding and postoperative epidural hematoma. However, in recent years, it has been reported that aspirin discontinuation before surgery may increase the risk of serious cardiovascular or cerebrovascular complications. In fact, studies about whether to stop aspirin before cervical surgery is still blank. Therefore, there is no consensus on whether or not to discontinue aspirin before the cervical surgery.

OBJECTIVE: To explore the effects of discontinuing aspirin on the risk of cardiovascular, cerebrovascular events and lower limb venous thrombosis and bleeding in the perioperative period of cervical surgery.

METHODS: This study collected 601 patients undergoing cervical surgical procedures in the Shandong Provincial Hospital, Shandong University from January 2012 to January 2015, and finally 440 cases were included according to the inclusion criteria. Patients who were aspirin users (n=22) were divided into 2 groups depending on whether to discontinue aspirin before the cervical surgery. The aspirin discontinuation group (n=10) discontinued their aspirin use 5 to 7 days before surgery, while the aspirin continuation group (n=12) continued aspirin use in the perioperative period. Totally 418 patients who did not use aspirin before surgery were selected as the control group. The risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis was quantitatively classified in the three groups and they were divided into low risk group and high risk group according to the criteria. The differences of risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis were evaluated in each group.

RESULTS AND CONCLUSION: (1) Of the 440 patients with cervical surgery, 22 patients (5%) had long-term aspirin use history. (2) The prevalence of hypertension, cardiovascular disease and cerebrovascular diseases in the aspirin group was higher than that in the control group. There was no difference in the prevalence of diabetes among the three groups. (3) There were no significant differences in the intraoperative blood loss, postoperative drainage, operation time, postoperative blood transfusion and postoperative plasma transfusion among the three groups. (4) The aspirin discontinuation group may have a higher incidence of cerebral infarction and pulmonary embolism than in the aspirin continuation group. (5) The aspirin continuation before the cervical surgery is safe in the perioperative period of cervical surgery and it is necessary to continue aspirin use to reduce the incidence of intraoperative and postoperative complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Aspirin, Cervical Vertebrae, Hemorrhage, Intraoperative Complications, Tissue Engineering

CLC Number:

R318

Zhang Cheng-gui, Wang Guo-dong, Sun Jian-min, Liu Le. Effects of aspirin discontinuation on the risk of cardiovascular and cerebrovascular events and lower limb venousthrombosis and bleeding in the perioperative period of cervical surgery[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(23): 3703-3709.

Figures/Tables 2

2.3 各组患者临床资料比较 2.3.1 患者基本状况比较见表2。阿司匹林停服组、继续服用组、未用组3组平均年龄分别为(65.1±10.2)岁，(63.4±9.5)岁，(62.2±6.4)岁，3组之间差异无显著性意义(P=0.653)；3组间高血压病的比例分别为60%(6/10)，58%(7/12)，29%(120/418)，3组之间差异有显著性意义(P=0.020)；3组间心血管疾病的比例分别为30%(3/10)，33%(4/12)，7%(30/418)，3组之间差异有显著性意义(P=0.016)；3组间脑血管疾病的比例分别为20%(2/10)，25%(3/12)，9%(38/418)，3组之间差异有显著性意义(P=0.045)；3组间糖尿病的比例分别为30%(3/10)，42%(5/12)，17%(71/418)，3组之间差异无显著性意义(P=0.279)；此外3组之间在性别(P=0.785)、身体质量指数(P=0.145)、下肢静脉血栓(P=0.71)、吸烟(P=0.365)等方面差异也无显著性意义。 2.3.2 患者手术方式类型比较见表3。3组患者行颈椎手术治疗的方式包括颈椎后路和颈椎前路，后路术式分为椎管成形术(颈椎后路单开门减压内固定术或颈椎后路双开门减压内固定术)、颈椎后路减压植骨融合内固定术(单节段、双节段、三节段)，前路术式为颈椎前路减压植骨融合内固定术(单节段、双节段)。3组患者在手术方式上差异无显著性意义，3组患者采用的手术方式情况基本一致。 2.3.3 患者出血事件比较见表4。阿司匹林停服组、继续服用组、未用组3组患者术中出血量分别为(280±507)，(300±523)和(251±41) mL，3组之间比较差异无显著性意义(P > 0.05)；3组患者引流量分别为(109±99)，(127±103)和(120±83) mL，3组之间比较差异无显著性意义(P > 0.05)；3组患者手术时间分别为(130±80)，(125±85)和(120±76) min，3组之间比较差异无显著性意义(P > 0.05)；3组患者术后输红细胞分别为(1.8±1.1)，(1.6±0.9)和(1.5±0.5) U，3组之间比较差异无显著性意义(P > 0.05)；3组患者术后输血浆量分别为(0.3±0.5)，(0.2±0.7)和(0.2±0.6) U，3组之间比较差异无显著性意义(P > 0.05)；3组患者在术中出血量、术后引流量及术后输红细胞或血浆量等方面没有显著差异。 2.3.4 术后30 d发生的并发症比较见表5。将3组患者根据心血管事件及下肢静脉血栓风险量化评分表分为高危组和低危组，停服阿司匹林组(10例)中高危组5例、低危组5例，继续服用阿司匹林组(12例)中高危组5例、低危组7例，不服用阿司匹林组(418例)中高危组26例、低危组392例。停服阿司匹林高危组中有2例患者发生脑梗死，均为老年男性患者，且均患有冠心病，1例先后置入2个心脏支架，另1例先后置入3个心脏支架，均在手术前7 d停用阿司匹林，仔细询问病史既往并没有脑梗死发作征象，术后颅脑CT示多发梗死灶形成，脑梗死怀疑为停药后引起心脏支架血栓形成脱落后所致。既往1例不服用阿司匹林高危组中有1例患者发生脑梗死，患者术后出现不明原因言语不清、双上肢肌力降至0级、双下肢肌力降至0级，行颅脑CT示多发脑缺血、脑梗死、脑萎缩。均转至神经内科进行系统治疗。停服阿司匹林高危组中有2例患者发生肺栓塞，均为老年女性，1例既往有高血压病、冠心病，术前7 d停用阿司匹林，术后凌晨3点疼痛难忍，发现其右小腿肿胀，急查凝血五项示：D-二聚体4.82 mg/L，给予速碧林4 100 U皮下注射，于凌晨5：30分突然出现意识丧失，呼之不应，心电监测示室颤，积极抢救1 h无效后死亡。分析死亡原因为下肢深静脉血栓脱落导致肺栓塞后引起呼吸骤停。另1例患者为2个心脏支架置入者，考虑为停药后引起心脏支架血栓形成脱落后所致。停服阿司匹林高危组较未停服阿司匹林组及不用阿司匹林组更容易引起脑梗死(P=0.03)、肺栓塞(P=0.02)的发生，而在发生硬膜外血肿、深静脉血栓及感染方面无明显差异。 "

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