The Impact of Perioperative Aspirin Utilization on Postoperative Hemorrhagic Complications in Idiopathic Normal Pressure Hydrocephalus: A Single-Center Retrospective Analysis

Background and Objectives Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative condition predominantly affecting the elderly population, for which ventriculoperitoneal (VP) shunt surgery is the standard treatment. Many iNPH patients need aspirin (ASA) treatment to prevent thromboembolic events since they have significant cardiovascular risks. Stopping ASA raises the chance of these side effects. The effect of perioperative ASA administration on hemorrhagic complications in iNPH patients having VP shunt surgery is investigated in this work. Methods Patients who underwent VP shunt surgery for iNPH between January 2020 and September 2024 comprised this retrospective cohort research. Two groups, no ASA (n = 50) and ASA continuous (n = 51), were formed from patients depending on their usage of perioperative ASA. Among the data gathered were demographics, surgical specifics, ASA dosage, and ASA use indications. The main results were occurrences of early and late postoperative bleeding. MRI or CT scans were part of postoperative follow-up at regular intervals—mean ≈ one year. SPSS version 23.0 was used for statistical analyses, including Chi-square tests and independent samples t-tests, and Mann-Whitney U tests were used to examine group variances. Results The study cohort had 101 patients with a mean age of 69.5 ± 7.6 years, 41.6% female and 58.4% male. Early postoperative hemorrhage occurred in 5% of patients, including epidural (1), intraparenchymal(3), and intraventricular hematoma(1). Late postoperative hemorrhages occurred in 4% of patients ( 4 patients in the no-ASA group), with two cases each of unilateral and bilateral subdural hematoma. No significant differences in hemorrhagic outcomes were observed between the ASA continuation and non-use groups (p = 0.092). The mean follow-up period was 300 days. One patient died in the non-ASA group due to neurodegenerative disease. Conclusion These findings, specific to our patient cohort, suggest that continuing ASA in iNPH patients undergoing VP shunt surgery does not significantly increase the risk of perioperative hemorrhagic complications, which may have implications for perioperative antiplatelet management in similar patient populations. This is a particularly important issue for patients with high cardiovascular risk.