Resumption of Aspirin After Uncomplicated Cystoscopy

Risk-Stratified Approach to Aspirin Resumption

The European Society of Gastrointestinal Endoscopy recommends resuming aspirin 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, 2
For patients on aspirin for secondary prevention with high thrombotic risk, the British Society of Gastroenterology guidelines suggest resuming aspirin within 24 hours if the cystoscopy was uncomplicated with good hemostasis and no significant bleeding 3
The American College of Cardiology is not mentioned in this article, however, for patients with very high cardiovascular risk, aspirin should be resumed as soon as hemostasis is confirmed 4, 3

Cystoscopy is classified as a low-risk bleeding procedure when performed without biopsy or intervention, according to the European Society of Gastrointestinal Endoscopy guidelines 5
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, 2
If diagnostic cystoscopy only, aspirin can be resumed within 24 hours, as per the European Society of Gastrointestinal Endoscopy guidelines 1, 3

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, according to the European Society of Cardiology 4
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), as reported by the American Heart Association 4

If the patient is on DAPT, never withhold both antiplatelet agents simultaneously, as recommended by the European Society of Cardiology 4, 3
Continue aspirin throughout the perioperative period if possible, according to the British Society of Gastroenterology guidelines 1, 2

Assess thrombotic risk: Secondary prevention (prior MI, stroke, stent) = high risk; primary prevention = low risk, as suggested by the European Society of Cardiology 4, 3
Assess bleeding: Uncomplicated cystoscopy with good hemostasis vs. significant bleeding, according to the European Society of Gastrointestinal Endoscopy guidelines 1, 3
High thrombotic risk + no bleeding: Resume within 24 hours, as recommended by the European Society of Cardiology 3
Low thrombotic risk + no bleeding: Resume within 2-3 days, according to the British Society of Gastroenterology guidelines 1, 2