When should you hold Aspirin (acetylsalicylic acid) prior to trigger finger release surgery?

Aspirin Management Before Trigger Finger Release Surgery

For patients undergoing trigger finger release surgery, aspirin should be continued throughout the perioperative period unless the patient is at low risk for cardiovascular events, in which case it should be discontinued 7-10 days before surgery. 1

Risk Stratification Approach

Patients Who Should Continue Aspirin

• Patients with moderate to high cardiovascular risk:
  • Recent coronary stents
  • History of myocardial infarction
  • High ASCVD risk
  • Other guideline-based primary or secondary prevention indications

Patients Who Should Discontinue Aspirin (7-10 days before surgery)

• Patients at low cardiovascular risk without specific medical indications for aspirin therapy

Evidence-Based Rationale

The American College of Chest Physicians recommends continuing aspirin throughout the perioperative period for patients at moderate to high risk for cardiovascular events 1. This is supported by evidence showing that:

• Preoperative aspirin reduces operative morbidity and mortality in cardiac surgery patients 2
• CABG can be performed safely in patients on aspirin therapy with only a modest increase in bleeding risk 2
• Premature withdrawal of antiplatelet agents is associated with a 10% risk of all vascular events 3

For patients at low cardiovascular risk, discontinuing aspirin 7-10 days before surgery allows for complete restoration of platelet function 1, 4. A study by Cahill et al. demonstrated that all bleeding times normalized within 96 hours and all platelet function tests within 144 hours after stopping aspirin 4.

Special Considerations

Bleeding Risk

• Trigger finger release surgery is generally considered a low-to-moderate bleeding risk procedure
• For closed-space procedures, intramedullary spine surgery, or prostate surgery, aspirin discontinuation may be more strongly indicated 5

Timing of Resumption

• Aspirin should be restarted within 24-48 hours after surgery once adequate hemostasis is achieved 1

Common Pitfalls to Avoid

1. Indiscriminate discontinuation: Stopping aspirin in all patients without considering cardiovascular risk can lead to increased risk of thrombotic events
2. Failure to resume therapy: Not restarting aspirin promptly after surgery can increase cardiovascular risk
3. Inadequate timing: Discontinuing aspirin too close to surgery (less than 5 days) may not allow sufficient time for platelet function to normalize 4
4. Not distinguishing between aspirin and other antiplatelet agents: Unlike aspirin, clopidogrel and ticagrelor should be discontinued for at least 5 days before elective surgery, and prasugrel for at least 7 days 2

By following this evidence-based approach to aspirin management before trigger finger release surgery, clinicians can balance the risks of bleeding against the benefits of thrombosis prevention.