From the Guidelines
Aspirin should be discontinued at least 5 days prior to free flap plastic surgery to minimize the risk of bleeding complications. This recommendation is based on the latest guidelines from the French working group on perioperative haemostasis (GIHP) and the French study group on thrombosis and haemostasis (GFHT) 1. The time required for the full recovery of thromboxane A2 synthesis, which is inhibited by aspirin, is around 10 days, but recovery does not need to be total for haemostatic competence to be sufficient to safely undergo an invasive procedure.
Key Considerations
- The haemostatic safety threshold guaranteeing the absence of perioperative risk of bleeding associated with aspirin treatment has not been established 1.
- A three-day washout of aspirin may lead to an improvement in platelet functions, but it is often not sufficient for full correction of platelet functions 1.
- For procedures with a high risk of bleeding, such as neurosurgery or free flap plastic surgery, the goal is to completely correct the platelet functions inhibited by aspirin, which may require a longer washout period of at least 5 days 1.
Individualized Decision-Making
The decision to discontinue aspirin prior to free flap plastic surgery should be individualized based on the patient's specific cardiovascular risk, the complexity of the planned procedure, and surgeon preference. Patients with a high risk of thrombotic events may require a different approach, and the decision to continue or discontinue aspirin should be made in consultation with the patient's medical team. However, for most patients, discontinuing aspirin at least 5 days prior to surgery is recommended to minimize the risk of bleeding complications 1.
From the Research
Aspirin Administration Prior to Free Flap Plastic Surgery
- The decision to administer aspirin prior to free flap plastic surgery is complex and depends on various factors, including the patient's medical history and the type of surgery being performed 2, 3.
- Some studies suggest that preoperative aspirin administration may improve free flap success rates by preventing arterial thrombosis 4.
- However, other studies have found that postoperative aspirin therapy does not provide a significant improvement in free flap survival and may be associated with a higher complication rate 5.
- A study comparing postoperative anticoagulation regimens found that aspirin and low-molecular-weight heparin (LMWH) therapy demonstrate equivalent outcomes in terms of microvascular thrombosis, partial or total flap loss, hematoma, bleeding, deep venous thrombosis (DVT), pulmonary embolism, and death 6.
- Clinicians should weigh the potential benefits of reduced thrombotic events against the risks of complications, such as hematomas, when considering preoperative aspirin administration 4.
Considerations for Aspirin Administration
- Patients with established cardiovascular disease may benefit from continuing aspirin therapy during the perioperative period, unless they are undergoing closed-space surgery 3.
- Patients taking aspirin for primary prevention of cardiovascular disease may need to discontinue it during the perioperative period, especially if there is a high risk of bleeding 3.
- The choice of anticoagulation regimen should be individualized based on the patient's specific needs and medical history 3, 6.