From the Guidelines
Aspirin and Clexane (low molecular weight heparin) management before a procedure depends on the procedure type and individual bleeding risk, with aspirin often continued for minor procedures and stopped 5-7 days before major surgeries, while Clexane is usually stopped 24 hours before procedures with standard bleeding risk. The decision to withhold these medications should be made in consultation with a healthcare provider, considering the patient's thrombotic risk against bleeding risk 1. For minor procedures like dental work or cataract surgery, aspirin can often be continued, but for major surgeries, aspirin is typically stopped 5-7 days before the procedure to minimize bleeding risk 1. Clexane usually needs to be stopped 24 hours before procedures with standard bleeding risk, or 48 hours before high bleeding risk procedures, due to its shorter half-life of 4-7 hours 1. Some guidelines suggest that for low-risk procedures, aspirin does not need to be withheld, while for high-risk procedures, it may be stopped 5 days before the procedure 1. It's essential to weigh the thrombotic risk against bleeding risk and consider "bridging" instructions if necessary, as these medications are often prescribed for important reasons like preventing blood clots, heart attacks, or strokes 1. Key considerations include:
- Procedure type (minor vs. major surgery)
- Individual bleeding risk
- Aspirin's irreversible effect on platelets for their 7-10 day lifespan
- Clexane's shorter half-life of 4-7 hours
- Thrombotic risk vs. bleeding risk
- Potential need for "bridging" instructions.
From the Research
Aspirin and Clexane Management Prior to Procedures
- The decision to withhold aspirin and clexane prior to a procedure depends on various factors, including the type of procedure, patient's thromboembolic risk, and bleeding risk 2.
- For patients with low thromboembolic risk, most physicians (77-97%) would discontinue aspirin prior to a procedure, depending on the bleeding risk 2.
- For patients with high thromboembolic risk, a smaller percentage of physicians (1.6-18%) would discontinue aspirin, and some would consider substituting low molecular weight heparin (LMWH) for aspirin 2.
- The use of enoxaparin, a type of LMWH, has been studied in various clinical settings, including perioperative management of antithrombotic therapies 3, 4, 5.
- Enoxaparin has been shown to be effective and safe in preventing venous thromboembolism in patients undergoing major elective surgery 6.
- The optimal dose of enoxaparin for bridging therapy is uncertain, with studies comparing full-dose and half-dose regimens 4.
- Enoxaparin has been compared to unfractionated heparin in endovascular interventions, with enoxaparin showing a better performance in terms of efficacy and safety 5.