When to discontinue Acetylsalicylic Acid (Asa) before a cesarean section?

From the Guidelines

Aspirin (ASA) should be discontinued ≤ 7 days before a scheduled cesarean section to minimize bleeding risk. For women taking low-dose aspirin (81-100 mg daily) for prevention of preeclampsia or other pregnancy complications, it should ideally be stopped at 36 weeks of gestation or about one week before the anticipated delivery date [ 1 ]. However, for women taking aspirin for other medical indications such as cardiac conditions or previous stent placement, the decision to discontinue should be made in consultation with their cardiologist or specialist, as the risks of stopping may outweigh the benefits.

Key Considerations

• The recommendation to stop aspirin before surgery is based on its irreversible inhibition of platelet function, which increases bleeding risk [ 1 ].
• Since platelets have a lifespan of 7-10 days, stopping 5-7 days before surgery allows time for the body to produce enough new, functional platelets to maintain adequate hemostasis during and after the procedure.
• If a cesarean section is performed emergently and the patient has recently taken aspirin, the surgical team should be informed, as this may influence surgical approach and postoperative management.

Additional Guidance

• In patients without prior bleeding or thrombotic complications, consider the use of LMWH instead of aspirin in the last two weeks of pregnancy and continued until six weeks postpartum [ 1 ].
• The duration of LMWH postpartum could be extended in high-risk pregnancy or in women who have undergone C-section [ 1 ].

From the FDA Drug Label

If pregnant or breast-feeding ask a health professional before use. it is especially important to use aspirin during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it my cause problems in the unborn child or complications during delivery. The FDA drug label does not answer the question.

From the Research

Aspirin Use Before Cesarean Section

• There is no direct evidence in the provided studies regarding when to stop Asa (aspirin) before a cesarean section 2, 3, 4, 5, 6.
• However, the studies focus on thromboprophylaxis and anticoagulation management during and after cesarean delivery, which may be relevant to aspirin use.
• Aspirin is an antiplatelet agent and its use before surgery may increase the risk of bleeding.
• The studies discuss the use of low molecular weight heparin (LMWH) and other anticoagulants for thromboprophylaxis after cesarean delivery, but do not provide guidance on aspirin use specifically.

Thromboprophylaxis After Cesarean Delivery

• The studies suggest that LMWH is commonly used for thromboprophylaxis after cesarean delivery, particularly in patients with increased risk of venous thromboembolism 3, 4, 5.
• The optimal timing and duration of LMWH prophylaxis after cesarean delivery are not clearly established, but the studies suggest that it should be started shortly after delivery and continued until the patient is ambulatory 3, 4.
• The use of pneumatic compression stockings (PCS) is also recommended as a thromboprophylaxis strategy after cesarean delivery, particularly in patients who are at low risk of venous thromboembolism 6.

Management of Anticoagulation After Cesarean Delivery

• The studies emphasize the importance of careful management of anticoagulation after cesarean delivery to minimize the risk of bleeding and thrombotic complications 5, 6.
• The optimal timing for resuming anticoagulation after cesarean delivery is not clearly established, but the studies suggest that it should be individualized based on the patient's risk factors and clinical status 5.