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Continuation versus discontinuation of aspirin-based antiplatelet therapy for perioperative bleeding and ischaemic events in adults undergoing neurosurgery: protocol for a systematic review and meta-analysis
  1. Xinyan Wang,
  2. Xinxin Wang,
  3. Yun Yu,
  4. Ruquan Han
  1. Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Ruquan Han; ruquan.han{at}gmail.com

Abstract

Introduction Antiplatelet therapy is commonly used in primary or secondary prevention of atherosclerotic and thrombotic diseases, such as coronary artery disease, transient ischaemic attack or stroke. Recent studies noted that antiplatelet therapy should be continued perioperatively in patients at high risk of thrombosis and low bleeding risk in orthopaedic, spinal or urological surgery. However, evidence in neurosurgery is lacking. Thus, we aim to conduct a systematic review and meta-analysis to assess whether the continuous use of antiplatelet drugs in neurosurgery increases the risk of perioperative bleeding.

Methods and analysis We will search PubMed, Cochrane Central Register of Controlled Trials and Embase using a strategy that combines the terms aspirin, bleeding/ischaemic and neurosurgery. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Cochrane risk of bias tool for randomised controlled studies and the Newcastle-Ottawa Scale for observational studies (including cohort studies, case–control studies, case series). Discrepancies will be resolved by consultation with a third researcher. We will conduct a systematic review and meta-analysis. If evidence suggests moderate statistical or clinical heterogeneity, we plan to investigate this heterogeneity by performing subgroup analyses and sensitivity analysis.

Ethics and dissemination No ethics approval will be sought as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO registration number CRD42020202590.

  • neurosurgery
  • stroke
  • anticoagulation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors XinyW: study design, conduct of study, bibliographic research, design of data entry forms, data management, protocol and manuscript writing and review. XinxW: bibliographic research design and conduct, protocol and manuscript review. YY: protocol and manuscript review. RH: study conception and design, scientific coordination, protocol and manuscript writing and review. All authors agreed to publish this protocol and to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported by funding from Ministry of Science and Technology of the People’s Republic of China funding (2018YFC2001901) and Clinical Medicine Development of Special Funding Support from the Beijing Municipal Administration of Hospitals (ZYLX201708; DFL20180502).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.