From the Guidelines
You should typically stop taking aspirin 5 days before surgery for procedures with a high risk of bleeding, as this allows for sufficient recovery of platelet function, according to the most recent and highest quality study 1. When considering the discontinuation of aspirin before surgery, it's essential to weigh the risks of bleeding against the risks of thrombotic events. The decision to stop aspirin should be made on a case-by-case basis, taking into account the type of surgery, the patient's individual risk factors, and the potential consequences of bleeding or thrombosis.
- Aspirin affects platelets for their entire lifespan, which is normally about 10 days, by irreversibly inhibiting their function 1.
- However, recovery of platelet function does not need to be total for haemostatic competence to be sufficient to safely undergo an invasive procedure 1.
- 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.
- For procedures with a high risk of bleeding, such as neurosurgery, it is proposed that invasive procedures should be performed only after five days of aspirin washout 1.
- It's crucial to follow the specific instructions of the surgeon or healthcare provider, as they may recommend a different timeframe based on individual risk factors.
- If you're taking aspirin for heart disease or stroke prevention, discuss with your doctor about the risks of temporarily stopping it, and never stop aspirin on your own without medical guidance, especially if you have a stent or history of heart attack.
- The American College of Chest Physicians also suggests continuing ASA around the time of surgery instead of stopping it 7 to 10 days before surgery for certain patients, such as those undergoing CABG surgery 1.
From the Research
Recommended Duration to Discontinue Aspirin Before Surgery
The recommended duration to discontinue Acetylsalicylic acid (Aspirin) before surgery varies depending on the type of surgery and the patient's risk profile.
- For elective non-cardiopulmonary bypass (CPB) surgery, monotherapy with clopidogrel or aspirin may not need to be discontinued 2.
- For elective surgery requiring CPB, it is recommended to discontinue aspirin 7 days preoperatively in patients with a low risk profile 2.
- A systematic review and meta-analysis found that early discontinuation of aspirin (3-5 or more days before surgery) showed a decreased risk of peri-operative bleeding, while late discontinuation (<3-5 days)/no discontinuation of aspirin did not increase the risk of major adverse cardiac events (MACE) 3.
- Another study recommends stopping aspirin more than 7-10 days preoperatively for patients undergoing spine surgery 4.
- A meta-analysis of 10 studies found that preoperative aspirin use increased the risk of bleeding in patients undergoing coronary artery bypass grafting surgery, with a significant increase in blood loss and transfusion of red blood cells and fresh frozen plasma in the aspirin group 5.
- A comprehensive update on aspirin management during noncardiac surgery suggests that patients taking aspirin for primary prevention of cardiovascular disease should likely discontinue it during the perioperative period, while patients with established cardiovascular disease may need to continue aspirin unless undergoing closed-space surgery 6.
Key Considerations
- The decision to discontinue aspirin before surgery should be made on a patient-specific basis, taking into account the type of surgery, the patient's risk profile, and the potential risks and benefits of aspirin use.
- Perioperative clinicians should balance the risks of ceasing aspirin before surgery against its continuation during the perioperative interval.
- Further research is needed to provide clear guidance on the optimal management of aspirin during the perioperative period.