From the Research
It is generally safe to stop aspirin 6 days before an epidural steroid injection and resume it 24 hours after the procedure in patients with a history of stroke, but this decision should always be made in consultation with your healthcare providers. The recommended timing allows for adequate recovery of platelet function before the procedure, which reduces bleeding risk during the epidural injection. Aspirin irreversibly inhibits platelet function, and it takes about 5-7 days for the body to produce enough new platelets to restore normal clotting function 1. The 24-hour waiting period after the procedure allows time for initial healing at the injection site before reintroducing the blood-thinning effects of aspirin. However, for stroke patients, the decision involves balancing the risk of bleeding during the procedure against the risk of stroke recurrence while off aspirin.
Some key considerations include:
- The risk of recurrent stroke and the timing of the last stroke event
- The presence of other risk factors for stroke or bleeding
- The use of additional anticoagulant medications
- The potential need for a shorter aspirin-free period or temporary bridging with alternative medications for high-risk patients
According to the most recent and highest quality study, antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally and started within 48 hours of onset of presumed ischemic stroke, significantly decreased death and dependency, and reduced the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications 1. This study supports the use of aspirin in stroke patients, but the decision to stop and restart aspirin around an epidural steroid injection should be individualized and made in consultation with healthcare providers.
In terms of specific management, the addition of or a switch to another antiplatelet agent, versus aspirin monotherapy, was associated with reduced risks of major adverse cardiovascular events and recurrent stroke 2. However, this should be considered 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 during the procedure with the risk of stroke recurrence while off aspirin, and to prioritize the patient's overall morbidity, mortality, and quality of life.