Aspirin Resumption After Blood Patch

Timing of Resumption

• The American College of Chest Physicians recommends resuming antiplatelet drugs ≤ 24 hours instead of > 24 hours after surgery or procedures in patients who require antiplatelet drug interruption for an elective procedure, including blood patch procedures 1
• For high cardiovascular risk patients, aspirin should be restarted as soon as hemostasis is confirmed, ideally within the first 24 hours post-procedure 1, 2

Risk Stratification Algorithm

• For patients with high thrombotic risk, such as those with recent stent, recent stroke/MI, or acute coronary syndrome, aspirin should be resumed within 24 hours of blood patch if no active bleeding 1, 2
• For patients with moderate thrombotic risk, such as those with stable coronary disease or prior stroke >3 months, aspirin should be resumed within 24 hours of blood patch 1

Bleeding Risk Assessment

• If uncomplicated blood patch with good hemostasis, aspirin should be resumed within 24 hours 1, 4
• If significant bleeding complication or expanding hematoma, aspirin should be withheld until bleeding is controlled, but reassess daily as prolonged discontinuation increases thrombotic risk 2, 4

Common Pitfalls to Avoid

• Unnecessarily prolonged discontinuation of aspirin beyond 24-48 hours significantly increases thrombotic risk and mortality, particularly in patients on aspirin for secondary prevention 2, 3
• In patients on dual antiplatelet therapy (DAPT), never withhold both agents simultaneously; if aspirin must be held longer, continue the P2Y12 inhibitor to prevent stent thrombosis 2, 3