Randomized pilot trial of postoperative aspirin in subarachnoid hemorrhage

Objective: To assess the safety and feasibility of a clinical trial on the effectiveness of acetylsalicylic acid (ASA) in subarachnoid hemorrhage (SAH ). Background: Several studies have indicated that increased platelet activ ity might be involved in the pathogenesis of delayed cerebral ischemia (DCI ) after SAH. Method: Fifty patients who had early surgery (less than or equ al to 4 days) for a ruptured aneurysm were enrolled in this randomized, dou ble-blind, placebo-controlled trial. Trial medication, consisting of suppos itories with 100 mg ASA versus placebo, was star ted immediately after surg ical clipping of the aneurysm and continued for 21 days. End points were fu nctional outcome and quality of life at 4 months, clinical deterioration af ter operation, development of DCI, hypodense lesion on postoperative CT, an d hemorrhagic complications. Results: One-third of all patients with aneury smal SAH were eligible for the trial. Fifteen of 26 patients receiving plac ebo deteriorated clinically versus 10 of 24 patients receiving ASA; 4 patie nts in each group deteriorated from DCI. Postoperative hypodensities on CT were observed in 27 patients, distributed equally in both groups. Functiona l outcome and quality-of-life scores were slightly in favor of patients who had received ASA, but not to a significant degree (p = 0.22). Two patients in the ASA group had an a symptomatic hemorrhagic complication, and one pa tient in the placebo group had a fatal and another a symptomatic hemorrhagi c complication. Conclusion: This pilot study shows that a clinical trial of acetylsalicylic acid (ASA) in subarachnoid hemorrhage (SAH) is feasible an d probably safe. The effectiveness of ASA on functional outcome and delayed cerebral ischemia has to be studied in a larger trial.