From the Guidelines
Aspirin should be stopped 3 days before surgery for most elective invasive procedures, according to the most recent guidelines. This recommendation is based on the study by the French working group on perioperative haemostasis (GIHP) and the French study group on thrombosis and haemostasis (GFHT) published in 2018 1. The study proposes that the last intake of aspirin should be on D-3 (D0 corresponds to the day of the procedure) for most invasive procedures.
However, there are exceptions to this general rule. For example, in the case of intracranial neurosurgery, aspirin should be stopped 5 days before the procedure 1. It's also important to note that the decision to stop aspirin should be made on a case-by-case basis, taking into account the individual patient's risk of bleeding and thrombotic complications.
Some key points to consider when deciding when to stop aspirin before surgery include:
- The type of surgery being performed
- The patient's underlying medical conditions, such as a history of heart attack, stroke, or stents
- The patient's current medications, including other antiplatelet agents or anticoagulants
- The risk of bleeding versus the risk of thrombotic complications
It's essential for patients to communicate clearly with their healthcare team about all medications they are taking, including over-the-counter products containing aspirin, well in advance of any scheduled procedure. The healthcare team can then make an informed decision about when to stop aspirin, based on the most recent guidelines and the individual patient's needs 1.
From the Research
Aspirin Cessation Before Surgery
- The optimal timing for aspirin cessation before surgery is still a topic of debate, with varying recommendations based on individual patient risk factors and the type of surgery being performed 2, 3.
- Studies suggest that 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 2.
- For patients with established cardiovascular disease, the decision to continue or discontinue aspirin should be made on a case-by-case basis, taking into account the patient's individual risk factors and the type of surgery being performed 2, 4.
- Some studies have investigated the optimal timing of aspirin cessation before noncardiac surgeries, with one pilot study suggesting that reducing the time of aspirin cessation from 7-10 days to 4-5 days may be possible without increased perioperative complications 3.
- Another study found that aspirin withdrawal 5 days before high-bleeding-risk procedures was associated with functional platelet recovery, and its reintroduction 2 days after surgery restored antiplatelet efficacy 5 days later 5.
Platelet Function and Aspirin Cessation
- 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 4.
- The high prevalence of normal platelet function in patients taking aspirin suggests that there may be no necessity for discontinuation before procedures in such patients 4.
- Abnormal platelet function can occur even in patients who are not taking aspirin, highlighting the importance of individualized assessment and decision-making 4.
Clinical Recommendations
- The decision to continue or discontinue aspirin before surgery should be based on a comprehensive evaluation of the patient's individual risk factors, including their cardiovascular risk profile and the type of surgery being performed 2, 6.
- Further research is needed to provide definitive guidance on the optimal management of aspirin in the perioperative period, particularly for patients with high cardiovascular risk 2, 6.