From the Guidelines
For a patient on baby aspirin 81 mg daily for preventative reasons who is undergoing non-invasive mitral valve repair, aspirin should be discontinued 5-7 days before surgery. This recommendation is based on the understanding that aspirin irreversibly inhibits platelet cyclooxygenase, preventing the formation of thromboxane A2 and impairing platelet aggregation, with the effect lasting for the lifespan of the platelet (approximately 7-10 days) 1. As new platelets are continuously produced, hemostatic function begins to normalize after 5 days when enough new platelets have entered circulation.
However, it's crucial to individualize this recommendation based on the patient's specific cardiovascular risk factors. Patients with recent coronary stents, history of stroke, or high thrombotic risk may require a different approach, possibly continuing aspirin through surgery or stopping for a shorter period, as suggested by the guideline that a consensus decision as to the relative risks of discontinuation or continuation of antiplatelet therapy can be useful 1. The decision should be made in consultation with both the cardiac surgeon and cardiologist, balancing bleeding risk during surgery against thrombotic risk from aspirin discontinuation.
Key considerations include:
- The patient's overall cardiovascular risk profile
- The type of surgery being performed (in this case, non-invasive mitral valve repair)
- The potential risks and benefits of continuing or discontinuing aspirin therapy perioperatively
- The guideline recommendation that management of perioperative antiplatelet therapy should be determined by consensus of treating clinicians and the patient 1
After surgery, aspirin can typically be resumed 24-48 hours postoperatively once hemostasis is achieved, considering the patient's individual risk factors and the clinical circumstances. It's also important to note that the guideline suggests continuing statins in patients currently taking statins and considering perioperative initiation of statin use in patients undergoing vascular surgery or with clinical risk factors undergoing elevated-risk procedures 1.
From the Research
Aspirin Management for Non-Invasive Mitral Valve Repair
- The optimal management of aspirin therapy in patients undergoing non-invasive mitral valve repair is not well established, and the decision to continue or discontinue aspirin should be made on a patient-specific basis 2.
- For patients taking aspirin for primary prevention of cardiovascular disease, it is likely recommended to discontinue aspirin during the perioperative period, especially when there is a high risk of bleeding 2.
- However, the provided studies do not specifically address the duration of aspirin cessation prior to non-invasive mitral valve repair.
- Studies on antithrombotic therapy after mitral valve repair suggest that aspirin may be a suitable option for preventing thromboembolic complications, with a lower risk of bleeding compared to oral anticoagulants 3, 4.
- A scoping review on the efficacy and safety of anti-thrombotic therapy after surgical mitral valve repair found that existing literature is inconclusive due to design limitations, and a pragmatic randomized controlled trial is needed to provide definitive evidence 5.
- A study on the peri-procedural management of anti-platelets and anticoagulation in patients undergoing the MitraClip procedure proposes practical management guidelines, but does not provide specific recommendations on the duration of aspirin cessation prior to the procedure 6.