When can a pregnant patient stop taking baby (acetylsalicylic acid) aspirin?

When to Stop Baby Aspirin in Pregnancy

Low-dose aspirin should be discontinued 1-2 weeks before expected delivery (around 36-37 weeks gestation) to minimize bleeding risk during delivery. 1

Timing of Aspirin Discontinuation

Different guidelines provide slightly varying recommendations on when to stop low-dose aspirin in pregnancy:

• 36 weeks gestation: Recommended by Polish guidelines 1
• 36-37 weeks gestation: Recommended by European Society of Cardiology 1
• Not before 35 weeks: Recommended by French and Tunisian guidelines 1
• Not before 37 weeks: Recommended by SOMANZ (Society of Obstetric Medicine of Australia and New Zealand) 1
• Continue until delivery: Recommended by Canadian, Irish, New Zealand, US, and NICE guidelines 1

Safety Considerations for Discontinuation

The timing of aspirin discontinuation balances two important factors:

1. Continued preeclampsia prevention: Maintaining aspirin therapy as long as possible provides continued protection against preeclampsia
2. Bleeding risk during delivery: Stopping aspirin before delivery reduces potential bleeding complications

The FDA drug label specifically warns about aspirin use during the last 3 months of pregnancy unless definitely directed by a doctor, as it "may cause problems in the unborn child or complications during delivery." 2

Special Considerations

For High-Risk Pregnancies

• In patients with myeloproliferative neoplasms or other high-risk conditions, consider stopping low-dose aspirin 1-2 weeks prior to delivery and switching to LMWH (low molecular weight heparin) for the last two weeks of pregnancy 1
• LMWH should be stopped 12-24 hours before labor is expected 1

For Epidural Anesthesia

• Consultation with a high-risk obstetrician and obstetric anesthesiologist is recommended regarding optimal timing of aspirin discontinuation if epidural anesthesia is planned 1

For Surgical Delivery

• If cesarean section is planned, aspirin should be discontinued one week prior to the surgical procedure 1
• Aspirin can be restarted 24 hours after surgery when considered acceptable depending on bleeding risk 1

Postpartum Considerations

• For women who were taking aspirin for preeclampsia prevention, aspirin should be continued for six weeks postpartum in high-risk cases 1
• The duration of anticoagulation postpartum may be extended in high-risk pregnancy or in women who have undergone C-section 1

Common Pitfalls to Avoid

1. Stopping too early: Discontinuing aspirin before 35 weeks may reduce its protective effect against preeclampsia
2. Not stopping before delivery: Failing to stop aspirin before delivery in cases where epidural anesthesia is planned may increase bleeding risk
3. Not considering individual risk factors: The decision about when to stop aspirin should consider the patient's specific risk factors for both preeclampsia and bleeding

Remember that the timing of aspirin discontinuation should be discussed with the patient's obstetrician, as individual factors may influence the optimal approach for each patient.