From the Research
Aspirin should generally not be discontinued in patients undergoing below-knee amputation (BKA) unless there are specific contraindications or high bleeding risk factors. For patients already on aspirin therapy for cardiovascular disease prevention or other indications, it is typically recommended to continue the medication through the perioperative period. The standard dose of 81-325 mg daily can usually be maintained. This recommendation is based on the understanding that the thrombotic risk of discontinuing aspirin often outweighs the bleeding risk, particularly in vascular patients who commonly require BKA. Patients undergoing BKA frequently have underlying peripheral arterial disease and other cardiovascular comorbidities that benefit from continued antiplatelet therapy, as supported by studies such as 1 which found that pre- and postoperative aspirin usage was associated with increased two-year secondary prosthetic graft patency. The surgical team should be informed about the patient's aspirin use, and hemostasis should be carefully monitored during and after surgery. In cases where bleeding risk is exceptionally high, a brief interruption of 3-7 days before surgery may be considered, but this decision should be individualized based on the patient's specific thrombotic and bleeding risk profile, considering the findings of studies like 2 which highlighted the increased risk of major hemorrhagic events with the addition of warfarin to aspirin. Resumption of aspirin should occur as soon as hemostasis is achieved postoperatively, typically within 24 hours after surgery, aligning with the safety and efficacy profile of aspirin as demonstrated in recent research such as 3.
Key considerations include:
- The patient's specific thrombotic and bleeding risk profile
- The presence of any contraindications to aspirin use
- The need for careful monitoring of hemostasis during and after surgery
- The potential benefits of continuing aspirin therapy for patients with underlying cardiovascular comorbidities
- The importance of individualizing the decision to interrupt aspirin therapy, if necessary, based on the patient's unique risk factors and clinical circumstances, as informed by studies such as 4 and 5.