SECA
Trial question
What is the effect of aspirin continuation in patients undergoing surgical treatment for chronic subdural hematoma?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
16.0% female
84.0% male
N = 155
155 patients (25 female, 130 male).
Inclusion criteria: adult patients receiving aspirin who presented with symptomatic chronic subdural hematoma and requiring surgical evacuation.
Key exclusion criteria: treatment with surgical techniques other than burr hole drainage; chronic subdural hematoma caused by a preexisting condition; recent major cardiac event; recent active bleeding event; known bleeding disorder; age < 18 years.
Interventions
N=78 aspirin discontinuation (discontinuation of aspirin for 12 days during perioperative phase).
N=77 aspirin continuation (continuation of 100 mg/day aspirin for 12 days during perioperative phase).
Primary outcome
Rate of recurrence of chronic subdural hematoma necessitating reoperation within 6 months
9.5%
13.9%
13.9 %
10.4 %
7.0 %
3.5 %
0.0 %
Aspirin
discontinuation
Aspirin
continuation
No significant
difference ↔
No significant difference in the rate of recurrence of chronic subdural hematoma necessitating reoperation within 6 months (9.5% vs. 13.9%; AD -4.4%, 95% CI -15.9 to 7.2).
Secondary outcomes
No significant difference in cardiovascular or thromboembolic event (0.28 per person half-year vs. 0.27 per person half-year; HR 1.1, 95% CI 0.55 to 2.22).
No significant difference in other bleeding events (0.108 per person half-year vs. 0.1 per person half-year; HR 0.86, 95% CI 0.26 to 2.77).
No significant difference in death (0.03 per person half-year vs. 0.06 per person half-year; HR 0.52, 95% CI 0.1 to 2.85).
Safety outcomes
No significant difference in severe adverse event.
Conclusion
In adult patients receiving aspirin who presented with symptomatic chronic subdural hematoma and requiring surgical evacuation, aspirin discontinuation was not superior to aspirin continuation with respect to the rate of recurrence of chronic subdural hematoma necessitating reoperation within 6 months.
Reference
Maria Kamenova, Lea Pacan, Christian Mueller et al. Aspirin Continuation or Discontinuation in Surgically Treated Chronic Subdural Hematoma: A Randomized Clinical Trial. JAMA Neurol. 2025 Apr 27:e250850. Online ahead of print.
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