Is it safe to proceed with egg pick-up in a patient with prothrombin mutation (heterozygous) who stopped taking aspirin (acetylsalicylic acid) only 9 days prior, considering the risk of bleeding or thrombosis?

Management of Aspirin Discontinuation Before Egg Pick-Up in Patient with Heterozygous Prothrombin Mutation

It is safe to proceed with egg pick-up 9 days after aspirin discontinuation in a patient with heterozygous prothrombin mutation, as platelet function normalizes within 4-5 days after stopping aspirin therapy.

Aspirin's Effect on Platelet Function and Recovery Timeline

• Aspirin irreversibly inhibits platelet cyclooxygenase (COX-1) through acetylation, preventing thromboxane A2 formation and resulting in antiplatelet effects 1
• After aspirin discontinuation, platelet function recovery depends on the generation of new platelets, which typically occurs within 4-5 days 2, 3
• Template bleeding times normalize within 96 hours (4 days) and all platelet function tests return to normal within 144 hours (6 days) after stopping aspirin therapy 3
• There is no demonstrable hemostatic defect persisting beyond the sixth day after aspirin cessation, regardless of whether the dose was 75 mg or 300 mg 3

Risk Assessment for Patients with Prothrombin Mutation

• Heterozygous carriers of the G20210A prothrombin gene mutation have an increased risk of first venous thromboembolism but similar risk of recurrent events compared to those with normal genotype (hazard ratio 1.3; 95% CI, 0.7-2.3) 4
• The French Working Group on Perioperative Haemostasis recommends a 5-day washout period for aspirin before procedures with high bleeding risk 5
• For procedures with low-to-moderate bleeding risk, aspirin can be continued perioperatively in patients with cardiovascular indications 5

Specific Recommendations for Egg Pick-Up Procedure

• Since 9 days have passed since aspirin discontinuation, platelet function has fully recovered, as this exceeds the 4-6 day window required for normalization 2, 3
• Egg pick-up procedures generally have a low-to-moderate bleeding risk profile, making the 9-day washout period more than adequate 5
• The risk of thrombosis during this brief period off aspirin is low for a patient with heterozygous prothrombin mutation without additional risk factors 4

Important Considerations and Monitoring

• Monitor for any signs of bleeding during and after the procedure, although the risk is minimal after 9 days of aspirin discontinuation 3
• Be aware that some patients may experience a transient prothrombotic state 7-10 days after aspirin withdrawal, though this effect is not well understood and clinical significance remains uncertain 6
• Consider resuming aspirin therapy soon after the procedure if it was originally prescribed for cardiovascular protection, especially if the patient has additional cardiovascular risk factors 5

Common Pitfalls to Avoid

• Unnecessarily postponing the procedure despite adequate aspirin washout period (9 days exceeds the required 4-6 days) 2, 3
• Confusing heterozygous prothrombin mutation with higher-risk thrombophilias that might require bridging anticoagulation 5
• Failing to distinguish between aspirin and other antiplatelet agents like clopidogrel, which requires a longer washout period of 10 days 2