Should aspirin (acetylsalicylic acid) be discontinued one day prior to surgery?

From the Guidelines

Aspirin should not be stopped just one day prior to surgery, but rather, the last intake of aspirin should be on D-3 (three days before the procedure) for most invasive procedures, as recommended by the French working group on perioperative haemostasis and the French study group on thrombosis and haemostasis 1. When considering the management of antiplatelet therapy in patients undergoing elective invasive procedures, it's crucial to balance the risk of bleeding against the risk of thrombotic events.

• The decision to stop aspirin before surgery depends on the type of surgery and the patient's medical condition.
• For most minor procedures, aspirin can be continued safely, but for major surgeries with significant bleeding risk, a more cautious approach is necessary.
• The French working group on perioperative haemostasis and the French study group on thrombosis and haemostasis propose that the last intake of aspirin should be on D-3 for most invasive procedures, except for intracranial neurosurgery, where it should be stopped on D-5 1.
• It's also important to consider the patient's individual risk factors, such as a history of heart attack, stroke, or stent placement, and to weigh the risks of stopping aspirin against the bleeding risks.
• The American College of Chest Physicians also suggests continuing aspirin around the time of surgery in moderate- to high-risk patients who are receiving acetylsalicylic acid (ASA) and require non-cardiac surgery, instead of stopping ASA 7 to 10 days before surgery 1.
• Ultimately, the decision to stop or continue aspirin before surgery should be made in consultation with both the surgeon and the physician who prescribed the aspirin, taking into account the individual patient's risk factors and the specific surgical procedure.

From the Research

Aspirin Management Before Surgery

• The decision to stop aspirin before surgery depends on various factors, including the patient's cardiovascular risk and the type of surgery [(2,3)].
• Patients taking aspirin for primary prevention of cardiovascular disease may be able to discontinue it before surgery, especially if there is a high risk of bleeding 2.
• However, patients with established cardiovascular disease, such as those with coronary artery disease or a history of stroke, may need to continue aspirin during the perioperative period to minimize the risk of thrombotic events [(2,3)].
• Some studies suggest that stopping aspirin 3-5 days before surgery may not increase the risk of major adverse cardiac events, but may reduce the risk of perioperative bleeding 4.

Risks and Benefits of Aspirin Continuation

• Continuing aspirin during the perioperative period may increase the risk of bleeding, but may also reduce the risk of thrombotic events [(2,3)].
• The use of antifibrinolytic agents, such as tranexamic acid, may help reduce bleeding in patients taking aspirin and clopidogrel before surgery 5.
• The decision to continue or discontinue aspirin before surgery should be made on a patient-specific basis, taking into account the individual's cardiovascular risk and the potential risks and benefits of aspirin therapy [(2,3)].

Clinical Guidelines and Recommendations

• Current clinical guidelines do not provide a unified answer on how to manage aspirin before surgery, and decisions should be made on a case-by-case basis [(2,3)].
• Patients with high cardiovascular risk may require closer monitoring and more individualized management of their aspirin therapy before surgery [(2,4)].
• Further research is needed to determine the optimal strategy for managing aspirin before surgery and to minimize the risks of bleeding and thrombotic events [(2,4)].