Management of aspirin in lumbar fusion: a systematic review and meta-analysis
In brief
Low-dose aspirin showed no significant increase in bleeding during lumbar fusion
In four observational studies involving 700 patients, continuing or stopping aspirin was not linked to significant differences in blood loss, drainage, operating time, hospital stay, complications, or mortality. Blood loss averaged 31 mL higher with aspirin, but the difference was not statistically significant; small, retrospective studies mean larger prospective trials are needed before firm guidance.
- Journal
- Journal of neurosurgical sciences (Q2)
- Published
- 1 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Leonardo DI Cosmo, Ely Feffer Barak, Francesca Pellicanò, Santiago Nieto Cuervo, Lorenzo DE Rossi, Sangya Ghosh, et al.
- PMID
- 42974825
- DOI
- 10.23736/S0390-5616.26.06762-7
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 8 November 2026): Perioperative aspirin management directly informs lumbar fusion care
Abstract
BACKGROUND: The perioperative management of acetylsalicylic acid (ASA) in spine surgery remains a daily clinical dilemma. While ASA discontinuation is traditionally recommended to minimize bleeding risk, cessation may expose patients with cardiovascular comorbidities to thromboembolic complications. In the absence of clear evidence-based guidelines, neurosurgeons frequently rely on institutional practices or personal judgment. METHODS: Following PRISMA guidelines, PubMed, EMBASE, Scopus, and Cochrane databases were searched for studies published from January 2000 to September 2025 comparing perioperative ASA use versus no ASA in adult lumbar fusion surgery. Random-effects models calculated mean differences (MD) with 95% confidence intervals (CI). Risk of bias was assessed using ROBINS-I. RESULTS: Four observational studies including 700 patients (316 ASA, 384 controls) were analyzed. ASA continuation or discontinuation did not significantly affect intraoperative blood loss (MD 31.29 mL; 95% CI -2.89 to 65.47; P=0.07), postoperative drainage, operative time, or hospital stay. Subgroup analysis stratified by timing of ASA discontinuation (≤3 days vs. ≥7 days) revealed no significant differences within or between subgroups. Complication rates, morbidity, and mortality were comparable across treatment arms. CONCLUSIONS: Continuation of low-dose ASA during lumbar fusion does not appear to increase perioperative bleeding, complications, or mortality. Given the potential cardiovascular risks of interruption, discontinuation should be reserved for carefully selected patients following multidisciplinary evaluation and individualized risk assessment. However, the available evidence in this field is limited by retrospective designs and small sample sizes, requiring further high-quality prospective trials to confirm these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.