Aspirin in Chronic Subdural Hematoma Surgery
Highlights
The SECA-Trial team from left to right: Prof. Jehuda Soleman and Dr. Maria Kamenova, University Hospital Basel, and Michael Coslovsky, Department of Clinial Research
The SECA Trial
Perioperative management of low-dose aspirin (acetylsalicylic acid, ASA) in patients undergoing surgery for chronic subdural hematoma (cSDH) is controversial. Clinicians must balance the risk of hematoma recurrence against the potential for cardiovascular or thromboembolic events when deciding whether to continue or discontinue ASA.
The DKF research group led by Prof. Jehuda Soleman conducted a multicentre, double-blind, placebo-controlled randomised clinical trial. Results were recently published in JAMA Neurol.
The study included 155 adults on ASA prior to cSDH who underwent burr hole drainage. Participants were randomised to either continue ASA or receive placebo for 12 days perioperatively. The main outcome was the recurrence rate of cSDH necessitating reoperation within 6 months.
Discontinuing aspirin around the time of surgery did not significantly reduce the risk of hematoma recurrence requiring reoperation within 6 months compared to continuing aspirin. Recurrence rates were 13.9% for those who continued aspirin and 9.5% for those who discontinued, a difference that was not statistically significant.
"The SECA trial is the first RCT in neurosurgery to evaluate perioperative antiplatelet management. It suggests that surgery for cSDH under ASA therapy is safer than previously assumed and questions the routine practice of preoperative ASA discontinuation, with potential implications for a paradigm shift in perioperative care."
Prof. Jehuda Soleman​
​
Lead consultant Department of Neurosurgery, University Hospital Basel and deputy head Pediatric Neurosurgery at the University Children's Hospital Basel (UKBB)
Publication
First author
Principal Investigator and last author
Prof. Jehuda Soleman, Lead consultant Department of Neurosurgery, University Hospital Basel and deputy head Pediatric Neurosurgery at the University Children's Hospital Basel (UKBB)
_
Study design
Multicentre, double-blind, placebo-contrleled randomised clinical trial
_
Key data
6 neurosurgical centres in Switzerland
155 patients
Enrolment February 2018 to June 2023
_
Funding
Swiss National Science Foundation, the Gottfried und Julia Bangerter-Rhyner-Stiftung, and the propatient Research Foundation of the University Hospital of Basel.