When to withhold Acetylsalicylic Acid (ASA) before left heart catheterization?

From the Guidelines

Aspirin (ASA) should typically be continued before a left heart catheterization procedure. For patients already on aspirin therapy, they should take their regular dose on the day of the procedure. The decision to withhold ASA before left heart catheterization should be based on individual patient risk factors, such as active bleeding, severe thrombocytopenia (platelet count <50,000), or a documented true aspirin allergy.

Key Considerations

• The benefits of continuing ASA generally outweigh the slightly increased risk of bleeding during the procedure for most patients, as it inhibits platelet aggregation, reducing the risk of thrombotic complications that can occur during the procedure when catheters and wires may damage the endothelium of blood vessels 1.
• According to the American College of Chest Physicians clinical practice guideline, there is no clear recommendation to withhold ASA before left heart catheterization, and the focus is on managing P2Y12 inhibitors in patients with coronary stents placed within the last 3 to 12 months 1.
• The antiplatelet effect of ASA is particularly important if percutaneous coronary intervention (PCI) with stent placement might be performed during the same procedure.

Patient-Specific Factors

• Active bleeding: ASA should be withheld in cases of active bleeding to minimize the risk of exacerbating the bleeding.
• Severe thrombocytopenia (platelet count <50,000): ASA should be withheld in cases of severe thrombocytopenia to minimize the risk of bleeding.
• Documented true aspirin allergy: ASA should be withheld in cases of a documented true aspirin allergy to prevent an allergic reaction.

From the Research

Aspirin Management Before Left Heart Catheterization

• The decision to withhold Acetylsalicylic Acid (ASA) before left heart catheterization depends on various factors, including the patient's medical history and the type of procedure being performed 2, 3.
• Patients with established cardiovascular disease, including those with coronary artery disease, cerebrovascular disease, and peripheral artery disease, should continue ASA unless there is a high risk of bleeding or other contraindications 2, 3.
• For patients undergoing noncardiac surgery, including left heart catheterization, the risks and benefits of continuing or withholding ASA should be carefully weighed, taking into account the patient's individual risk factors and the type of procedure being performed 2, 3.
• In general, ASA should be continued in patients with a history of coronary stenting, unless there is a high risk of bleeding or other contraindications 2, 3.
• If ASA must be withheld, the patient's antiplatelet therapy should be managed carefully to minimize the risk of thrombotic events, and alternative antiplatelet agents may be considered 4, 3.

Specific Considerations

• Patients with aspirin hypersensitivity or intolerance may require alternative antiplatelet therapy or desensitization procedures to allow for the safe use of ASA 5, 6.
• The use of dual antiplatelet therapy, including ASA and a P2Y12 inhibitor, is recommended for patients undergoing coronary stent implantation, unless there are contraindications 4, 3.
• The duration of dual antiplatelet therapy should be individualized based on the patient's risk factors and the type of stent implanted, but is typically recommended for at least 6-12 months after drug-eluting stent implantation 4, 3.