From the Guidelines
Aspirin should be stopped at least 5 days before elective surgery, but the decision to stop aspirin should be made in consultation with both the surgeon and cardiologist, taking into account the individual patient's risk of bleeding and thrombotic events. The management of antiplatelet therapy, including aspirin, in patients undergoing elective invasive procedures is a complex issue that requires careful consideration of the patient's underlying medical conditions and the type of surgery being performed 1. While aspirin is often discontinued before surgery to reduce the risk of bleeding, this decision should be made on a case-by-case basis, as stopping aspirin may also increase the risk of thrombotic events, particularly in patients with a history of cardiovascular disease 1.
Some studies suggest that aspirin can be safely continued in patients undergoing low-risk surgical procedures, while others recommend discontinuing aspirin at least 5 days before high-risk procedures, such as neurosurgery 1. The French Working Group on Perioperative Haemostasis recommends that aspirin be discontinued at least 3 days before elective surgery, but notes that this recommendation may need to be adjusted based on individual patient factors 1.
In patients taking aspirin for secondary prevention, the decision to stop aspirin should be made in consultation with both the surgeon and cardiologist, as stopping aspirin may carry risks, including an increased risk of myocardial infarction and stroke 1. Some studies have shown that continuing aspirin perioperatively may reduce the risk of cardiac events, but may also increase the risk of bleeding 1.
Ultimately, the decision to stop aspirin before surgery should be based on a careful assessment of the patient's individual risk factors and the type of surgery being performed. Patients should always inform their surgical team about all medications they are taking, and follow their specific instructions regarding aspirin management before their procedure. The most recent and highest quality study on this topic, published in 2018, recommends that aspirin be discontinued at least 5 days before high-risk surgical procedures, but notes that this recommendation may need to be adjusted based on individual patient factors 1.
From the Research
Recommended Duration to Withhold Acetylsalicylic Acid (Aspirin) Before Surgery
- The recommended duration to withhold Acetylsalicylic acid (Aspirin) before surgery is controversial, with different studies suggesting different time frames 2, 3, 4, 5, 6.
- A study published in the Journal of the American College of Surgeons in 2005 found that all bleeding times normalized within 96 hours and all platelet function tests within 144 hours after stopping aspirin, suggesting that aspirin therapy can be discontinued 5 days before elective surgery 2.
- Another study published in The Cochrane database of systematic reviews in 2018 found that either continuation or discontinuation of antiplatelet therapy before non-cardiac surgery may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events, but the evidence was limited to few studies with few participants 3.
- A systematic review and meta-analysis published in Catheterization and cardiovascular interventions in 2017 found that planned short-term discontinuation of aspirin in the appropriate clinical setting appears to be safe with no increased risk of thrombotic events and with a decreased risk of bleeding 4.
- A study published in Surgical endoscopy in 2016 found that continuation of aspirin is safe and should be preferred in patients with higher cardiovascular risk undergoing elective primary inguinal hernia repair 5.
- A review published in Surgical neurology international in 2018 suggested that low-dose aspirin should be stopped 10 days or longer prior to spine surgery to avoid postoperative epidural hematoma/paralysis, but noted that each spine surgeon must determine what is in the "best interest" of their individual patient 6.
Key Findings
- The optimal duration for withholding aspirin before surgery is not well established and may vary depending on the individual patient and the type of surgery 2, 3, 4, 5, 6.
- Discontinuation of aspirin therapy 5-10 days before surgery may be sufficient to minimize the risk of bleeding complications while also reducing the risk of thrombotic events 2, 4, 6.
- The decision to continue or discontinue aspirin therapy before surgery should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 3, 5, 6.