From the Guidelines
Aspirin should not be stopped before a procedure, as the most recent and highest quality study recommends continuing aspirin throughout the perioperative period, especially for patients undergoing coronary artery surgery 1. When considering the management of antiplatelet therapy in patients undergoing elective invasive procedures, it's essential to weigh the risks of bleeding against the risks of thrombosis.
- The French Haute Autorité de la santé (HAS) recommends that aspirin should not be given for three days before the procedure, but this recommended duration may be adjusted 1.
- However, the 2024 ESC guidelines for the management of chronic coronary syndromes suggest that low-dose aspirin should be continued until the day of coronary artery bypass grafting (CABG) and restarted as soon as there is no concern over bleeding, possibly within 24 hours of CABG 1.
- Other studies also support the continuation of aspirin during the perioperative period, especially for patients with heart disease or those at high risk of thrombosis 1.
- It's crucial to note that the decision to stop or continue aspirin should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.
- Ultimately, the goal is to balance the risk of bleeding against the risk of thrombosis, and continuing aspirin throughout the perioperative period may be the best approach for many patients, as recommended by the most recent and highest quality study 1.
From the Research
Stopping Aspirin Before a Procedure
To prevent bruising, it is essential to consider the timing of stopping aspirin before a procedure. The following points summarize the relevant information:
- There is no specific guideline on when to stop aspirin before a procedure to prevent bruising 2.
- The decision to stop aspirin should be based on the individual's benefit/risk ratio, considering the risk of bleeding and the need for antithrombotic therapy 3.
- Some studies suggest that aspirin can be continued during surgery for spinal degenerative disorders without an increased risk of postoperative bleeding 2.
- The effectiveness and safety of antiplatelet drugs, including aspirin, can vary depending on the individual's platelet count and reactivity 4.
Factors to Consider
When deciding when to stop aspirin before a procedure, the following factors should be considered:
- The type of procedure and the associated risk of bleeding
- The individual's medical history and current medications
- The presence of any bleeding disorders or platelet count abnormalities
- The potential benefits and risks of continuing or stopping aspirin therapy 3, 2, 4
Current Research
Recent studies have investigated the efficacy and safety of low-dose acetylsalicylic acid for the prevention of thromboembolic events in individuals with antiphospholipid antibodies 5. However, these studies do not provide specific guidance on when to stop aspirin before a procedure to prevent bruising.