From the Guidelines
Aspirin should not be discontinued preoperatively when prescribed for secondary prevention, but for patients taking aspirin for primary prevention, it is recommended to discontinue aspirin preoperatively to minimize bleeding risk, with the decision individualized based on the patient's specific cardiovascular risk profile 1. When considering the management of aspirin therapy in patients undergoing lumbar decompression surgery, it's crucial to weigh the risks of bleeding against the risks of cardiovascular events.
- For patients on aspirin for primary prevention, discontinuing the medication preoperatively may be considered to reduce the risk of bleeding, as suggested by the French working group on perioperative haemostasis (GIHP) and the French study group on thrombosis and haemostasis (GFHT) 1.
- However, for patients taking aspirin for secondary prevention, such as those with a history of cardiovascular events, the recommendation is to continue aspirin therapy perioperatively, unless the risk of bleeding is deemed high 1. The decision to stop or continue aspirin should be made in consultation with both the surgeon and the physician who prescribed the aspirin, taking into account the patient's individual risk factors and the specific surgical procedure planned 1.
- It's also important to consider the dose and duration of aspirin therapy, as well as the patient's overall health status, when making this decision.
- Ultimately, the goal is to balance the risk of bleeding against the risk of cardiovascular events, and to create a personalized plan that prioritizes the patient's safety and well-being 1.
From the Research
Aspirin Discontinuation Before Lumbar Decompression
- The decision to stop aspirin before lumbar decompression surgery should be based on the patient's individual risk factors and medical history 2, 3.
- Studies suggest that stopping aspirin 7-10 days before surgery may reduce the risk of perioperative bleeding complications 2, 3.
- However, some studies have found that continuing aspirin therapy during the perioperative period may not increase the risk of bleeding complications, especially in patients undergoing minimally invasive lumbar decompression surgery 4, 5.
- The use of anticoagulant and antiplatelet therapies in elective decompressive surgery may be devoid of early complications and could be safely continued perioperatively 4.
- A retrospective cohort study found no significant differences in perioperative outcomes and 1-year postoperative clinical results between patients who continued antiplatelet medication and those who discontinued it before minimally invasive posterior lumbar decompression surgery 5.
Considerations for Aspirin Discontinuation
- The risk of thrombotic events should be balanced against the risk of bleeding complications when deciding whether to stop aspirin before surgery 2, 3.
- Patient demographics, surgical details, and patient outcomes should be considered when evaluating the effectiveness of lumbar decompression surgery 6.
- The type and dose of antiplatelet medication, as well as the patient's medical history and risk factors, should be taken into account when making decisions about aspirin discontinuation 2, 3, 5.