From the Guidelines
Aspirin should be stopped 3 days before a procedure for most cases, but for procedures with high bleeding risk such as neurosurgery, it is recommended to stop aspirin 5 days before the procedure. This recommendation is based on the most recent and highest quality study available, which suggests that stopping aspirin 3 days before a procedure is sufficient for most patients, but for high-risk procedures, a longer duration of 5 days is recommended to ensure complete correction of platelet functions inhibited by aspirin 1. The decision to stop aspirin before a procedure depends on the type of procedure and the patient's cardiovascular risk, and should always be made in consultation with both the surgeon and the physician who prescribed the aspirin.
Some key points to consider when making this decision include:
- The type of procedure: for minor procedures such as dental work, cataract surgery, and many endoscopies, aspirin can typically be continued safely 1.
- The patient's cardiovascular risk: patients with recent coronary stents, history of stroke, or high cardiovascular risk may need to continue aspirin even before surgery, with the benefits of continued therapy outweighing bleeding risks.
- The risk of bleeding: for procedures with high bleeding risk, such as neurosurgery, prostate surgery, or complex orthopedic procedures, aspirin should generally be stopped 5 days before the procedure to minimize the risk of excessive bleeding 1.
It's also important to note that aspirin irreversibly inhibits platelets, affecting blood clotting for the lifespan of those platelets (about 7-10 days), and stopping aspirin when it's needed for cardiovascular protection can increase the risk of serious events like heart attack or stroke, while continuing it unnecessarily before major surgery can lead to excessive bleeding 1. Therefore, the decision to stop aspirin before a procedure should be made carefully, taking into account the individual patient's risk factors and the specific procedure being performed.
From the Research
Aspirin Management Before Procedures
The decision to stop or continue aspirin before a procedure is complex and depends on various factors, including the type of procedure, patient's medical history, and risk of bleeding or thrombotic complications.
- The risk of hypercoagulability associated with surgery is independent of antiplatelet withdrawal, but adds to the rebound effect of platelet responsiveness 2.
- Patients taking aspirin for primary prevention of cardiovascular disease should likely discontinue it during the perioperative period, especially when there is a high risk of bleeding 3.
- Patients with established cardiovascular disease but without a coronary stent should likely continue aspirin during the perioperative period unless undergoing closed-space surgery 3.
Specific Procedure-Related Considerations
- For patients undergoing coronary artery surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo 4.
- In patients taking aspirin before interventional procedures, the high prevalence of normal platelet function suggests no necessity of discontinuation before procedures in such patients 5.
- Aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication, and most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period 6.
Patient-Specific Strategy
- Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation 3, 6.
- Platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors 5.