Perioperative Aspirin Continuation After Surgery
Aspirin (ecospirin) should generally be continued or restarted as soon as possible after surgery in patients with established cardiovascular disease, typically within 24 hours once adequate hemostasis is achieved. 1, 2
Immediate Postoperative Management
Restart aspirin within 24 hours after surgery when bleeding is controlled. 2 The maximal antiplatelet effect occurs within 15-30 minutes after taking aspirin, so therapeutic benefit is rapidly achieved upon resumption. 1
For patients in whom aspirin was continued throughout surgery, maintain therapy without interruption postoperatively. 1, 2
Patient-Specific Considerations
High Cardiovascular Risk Patients
For patients with coronary artery disease, prior stroke, or peripheral arterial disease, aspirin should be restarted as soon as possible postoperatively, ideally within the first 24 hours. 2 Discontinuation of antiplatelet therapy increases the absolute risk of stroke recurrence or cardiovascular events by approximately 2% within 30 days. 1
Patients with Coronary Stents
In patients with coronary stents who required aspirin interruption, restart aspirin immediately postoperatively and resume the P2Y12 inhibitor as soon as possible. 1 This population faces exponentially higher thrombotic risk, with catastrophic stent thrombosis, death, and myocardial infarction clustering early after aspirin discontinuation. 3
Post-CABG Patients
Aspirin should be continued until the day of CABG and restarted as soon as there is no concern over bleeding, possibly within 24 hours. 1 Perioperative aspirin use in cardiac surgery is associated with reduced myocardial infarction risk and improved vein graft patency. 2
Post-Carotid Endarterectomy
For patients who underwent carotid endarterectomy, restart anticoagulation when considered safe from postoperative bleeding risk, typically 3-14 days after surgery. 1 However, aspirin is specifically recommended for continuation during carotid endarterectomy itself. 1, 2
Surgery-Specific Timing
High Bleeding Risk Procedures
For neurosurgery or other closed-space surgeries where even minor bleeding causes severe complications, delay aspirin resumption until the surgeon confirms adequate hemostasis and acceptable bleeding risk. 2 The decision requires direct communication between the surgical and medical teams.
Standard Surgical Procedures
For most non-cardiac surgeries including cardiovascular, vascular, orthopedic procedures, and epidural anesthesia, aspirin can be safely restarted within 24 hours as no clinically relevant bleeding complications have been reported. 4
Critical Caveats
Never assume aspirin can be safely withheld indefinitely postoperatively in cardiovascular disease patients. Thrombotic events cluster early after discontinuation, with the highest risk in the first 30 days. 1, 3
Avoid combining multiple antiplatelet or anticoagulant medications immediately postoperatively without careful risk assessment. Bleeding risk increases significantly with combination therapy. 2
Ensure thorough medication reconciliation, as patients may not report over-the-counter NSAID use with antiplatelet effects. 2 Concurrent NSAID use can impair aspirin's cardioprotective effects and increase bleeding risk. 1
For patients on dual antiplatelet therapy (DAPT), the P2Y12 inhibitor requires different timing than aspirin for maximal effect: clopidogrel takes 4-5 days with maintenance dosing (or 2-6 hours with loading dose), prasugrel takes 3 days, and ticagrelor takes 2 hours. 1 Plan resumption accordingly.