When can aspirin (acetylsalicylic acid) be resumed after an uncomplicated cystoscopy?

Resumption of Aspirin After Uncomplicated Cystoscopy

Aspirin should be resumed within 1-3 days after an uncomplicated cystoscopy, with the specific timing determined by the patient's thrombotic risk and whether any bleeding occurred during the procedure. 1

Risk-Stratified Approach to Aspirin Resumption

For Patients on Aspirin for Secondary Prevention (High Thrombotic Risk)

• Resume aspirin within 24 hours if the cystoscopy was uncomplicated with good hemostasis and no significant bleeding 2
• Resume as soon as hemostasis is confirmed in patients with very high cardiovascular risk (recent stent, recent stroke/MI, or acute coronary syndrome) 3, 2
• Delaying aspirin resumption beyond 24-48 hours significantly increases thrombotic risk and mortality in these patients 3, 2

For Patients on Aspirin for Primary Prevention (Low Thrombotic Risk)

• Resume aspirin within 2-3 days after the procedure if there are no bleeding complications 1
• Consider permanent discontinuation if the patient experienced significant bleeding, as the bleeding risk may outweigh cardiovascular benefit in primary prevention 1, 3

Procedure-Specific Considerations

Cystoscopy is classified as a low-risk bleeding procedure when performed without biopsy or intervention 1. The British Society of Gastroenterology and European Society of Gastrointestinal Endoscopy guidelines recommend that antiplatelet therapy can be continued or resumed quickly after low-risk procedures 1.

• If diagnostic cystoscopy only: Resume aspirin within 24 hours 1, 2
• If cystoscopy with biopsy or minor intervention: Resume aspirin within 1-2 days if hemostasis is adequate 1
• If significant bleeding occurred: Delay resumption until bleeding is controlled, but reassess daily 2

Critical Mortality and Morbidity Data

The evidence strongly supports early aspirin resumption in patients on secondary prevention:

• All-cause mortality is 10 times lower (1.3% vs 12.9%) in patients who resume aspirin immediately after endoscopic hemostasis compared to those who discontinue it 3
• Discontinuation of aspirin for secondary prevention is associated with a nearly sevenfold increase in risk for death or acute cardiovascular events (HR 6.9; 95% CI 1.4 to 34.8) 3
• The median time to coronary stent thrombosis can be as short as 7 days when antiplatelet therapy is withheld 3

Special Considerations for Dual Antiplatelet Therapy (DAPT)

If the patient is on DAPT (aspirin plus a P2Y12 inhibitor):

• Never withhold both antiplatelet agents simultaneously 3, 2
• Continue aspirin throughout the perioperative period if possible 1
• If the P2Y12 inhibitor was held, restart it within 1-2 days after the procedure for high-risk patients 1
• For patients with drug-eluting stents, resume the P2Y12 inhibitor within 5 days after the procedure 1, 3

Common Pitfalls to Avoid

• Unnecessarily prolonged discontinuation of aspirin beyond 24-48 hours, which dramatically increases thrombotic risk and mortality, particularly in patients on aspirin for secondary prevention 3, 2
• Failing to differentiate between primary and secondary prevention indications—the risk-benefit calculation is completely different 1, 3
• Simultaneous discontinuation of both antiplatelet agents in patients on DAPT, which can lead to stent thrombosis in as little as 7 days 3, 2
• Overlooking cardiovascular risk stratification—patients with recent stents, recent MI, or acute coronary syndrome require the most aggressive approach to early resumption 1, 2

Practical Algorithm

1. Assess thrombotic risk: Secondary prevention (prior MI, stroke, stent) = high risk; primary prevention = low risk 3, 2
2. Assess bleeding: Uncomplicated cystoscopy with good hemostasis vs. significant bleeding 1, 2
3. High thrombotic risk + no bleeding: Resume within 24 hours 2
4. Low thrombotic risk + no bleeding: Resume within 2-3 days 1
5. Any risk + active bleeding: Hold until bleeding controlled, but reassess daily 2