Aspirin 150mg Discontinuation Before Cesarean Section
Aspirin 150mg should be discontinued 1-2 weeks (7-14 days) before a planned cesarean section, with the procedure ideally performed after this washout period to allow for adequate platelet recovery.
Evidence-Based Timing for Cesarean Section
The most relevant guideline addressing aspirin discontinuation before cesarean delivery comes from the NCCN guidelines for myeloproliferative neoplasms, which specifically addresses pregnancy and delivery scenarios:
- Low-dose aspirin (50-100 mg/day) should be stopped 1-2 weeks prior to delivery, including cesarean section 1
- This recommendation applies to pregnant patients on aspirin therapy throughout pregnancy for thrombotic risk management 1
- The 1-2 week discontinuation window allows for complete platelet turnover, as aspirin irreversibly inhibits platelet function for the entire 7-10 day lifespan of affected platelets 2
Supporting Evidence from Surgical Guidelines
While not specific to cesarean section, multiple surgical guidelines provide consistent timing recommendations:
- For elective surgery with bleeding risk, aspirin should be discontinued one week (7 days) prior to the surgical procedure 1
- French perioperative guidelines recommend a 5-day washout period for high bleeding-risk procedures, though neuraxial procedures specifically require this minimum 2
- Research demonstrates that all bleeding times normalize within 96 hours and platelet function tests within 144 hours (6 days) after stopping aspirin 3
Cesarean Section-Specific Considerations
Cesarean section represents a moderate-to-high bleeding risk procedure where:
- The 1-2 week discontinuation window provides optimal safety margins for both maternal hemostasis and surgical field management 1
- Women who have undergone C-section may require extended postpartum thromboprophylaxis with LMWH rather than immediate aspirin resumption 1
- In high-risk pregnancies or those with prior thrombotic complications, LMWH may be substituted for aspirin in the final 2 weeks before delivery 1
Resumption After Cesarean Section
- Aspirin can be restarted 24 hours after surgery when adequate hemostasis is achieved and bleeding risk is acceptable 1
- For patients requiring thromboprophylaxis, the duration may be extended to 6 weeks postpartum 1
Critical Caveats
Do not apply shorter discontinuation periods (3-5 days) used for other procedures to cesarean section, as the pregnancy-specific guidelines explicitly recommend 1-2 weeks 1. The longer window accounts for:
- Pregnancy-related hypercoagulability requiring careful balance
- Potential for significant surgical bleeding in cesarean delivery
- Need for complete platelet function recovery in the peripartum period
For emergency cesarean sections, the risk-benefit calculation changes dramatically, and aspirin continuation may be necessary despite bleeding risk if the thrombotic risk is prohibitive 1.