Should aspirin (acetylsalicylic acid) be continued or discontinued in patients undergoing wound debridement?

Aspirin Management for Wound Debridement

For most wound debridement procedures, aspirin should be continued perioperatively, as the bleeding risk from this minor procedure does not outweigh the thrombotic risk of discontinuation, particularly in patients on aspirin for secondary cardiovascular prevention.

Risk Stratification Approach

Continue Aspirin (Preferred for Most Cases)

Wound debridement is generally a low-bleeding-risk procedure where aspirin continuation is safe and recommended. 1

• Patients on aspirin for secondary prevention (history of MI, stroke, peripheral arterial disease, or coronary stents) should continue aspirin through the procedure 1
• Aspirin continuation reduces major cardiac events by up to 80% in high-risk patients without excess bleeding in most surgical settings 1
• The 2024 AHA/ACC guidelines recommend continuing aspirin 75-100 mg in patients with prior PCI undergoing noncardiac surgery to reduce cardiac events 1
• Discontinuing antiplatelet therapy increases stroke recurrence risk by 2.02% and cardiovascular events by 1.83% within 30 days 1

Discontinue Aspirin (Rare Exceptions)

Aspirin discontinuation should only be considered in specific high-bleeding-risk scenarios:

• Primary prevention only: If aspirin is prescribed solely for primary prevention (no prior cardiovascular events), discontinuation 3 days before the procedure is reasonable 1, 2
• Closed-space bleeding concerns: If debridement involves areas where even minor bleeding could cause severe complications (e.g., near critical neurovascular structures), consider stopping aspirin 3 days preoperatively 1, 2
• Intracranial or spinal procedures: These require aspirin discontinuation 5 days before surgery 1

Timing of Discontinuation (When Indicated)

If discontinuation is deemed necessary:

• Stop aspirin 3 days before the procedure (last dose on D-3, where D0 = procedure day) 1, 2
• This allows sufficient platelet recovery for hemostasis, as only 20% of circulating platelets need normal function 3
• Resume aspirin 12-24 hours post-procedure once adequate hemostasis is achieved 2

Special Populations Requiring Continuation

Patients with Coronary Stents

Never discontinue aspirin in patients with recent coronary stents:

• Continue aspirin regardless of stent timing if dual antiplatelet therapy (DAPT) must be interrupted 1
• Risk of stent thrombosis with aspirin discontinuation far exceeds bleeding risk from wound debridement 1, 3
• If surgery is within 30 days of bare-metal stent or 3 months of drug-eluting stent, maintain DAPT if at all possible 1

Patients with Recent Stroke or TIA

• Continue aspirin to prevent recurrent ischemic events 1
• Discontinuation carries significant thrombotic risk that outweighs bleeding concerns in wound debridement 1

Patients with Peripheral Arterial Disease

• Continue aspirin as these patients have high cardiovascular event risk perioperatively 1

Critical Pitfalls to Avoid

• Do NOT bridge with heparin or LMWH when discontinuing aspirin—this increases bleeding risk without preventing thrombotic events 1, 2
• Do NOT routinely discontinue aspirin for all procedures—this outdated practice increases mortality and morbidity 1, 4, 3
• Do NOT assume all bleeding is clinically significant—most studies show increased bleeding with aspirin is not clinically relevant for most procedures 4, 5
• Do NOT delay resumption of aspirin postoperatively—restart within 12-24 hours unless active bleeding 2

Evidence Quality Considerations

The 2018 French guidelines provide the most comprehensive perioperative antiplatelet management framework, emphasizing that aspirin monotherapy need not be discontinued for most noncardiac surgeries 1. The 2024 AHA/ACC guidelines reinforce aspirin continuation in patients with coronary disease 1. The POISE-2 trial showed aspirin increased bleeding but did not reduce MI/mortality in low-risk patients; however, this cannot be extrapolated to high-risk patients with established cardiovascular disease 1.

For wound debridement specifically, the bleeding risk is minimal compared to major surgery, making aspirin continuation the safest approach for the vast majority of patients.