Perioperative Aspirin Management Guidelines

Introduction to Aspirin Management

The American College of Chest Physicians recommends stopping aspirin ≤7 days before elective non-cardiac surgery when interruption is necessary, and resuming within 24 hours postoperatively once hemostasis is achieved 1

Patients with coronary stents should continue aspirin throughout the perioperative period, regardless of stent type, as premature discontinuation markedly increases risk of catastrophic stent thrombosis, death, and myocardial infarction 2
The American Heart Association recommends continuing aspirin perioperatively for CABG surgery, as it reduces myocardial infarction risk and improves vein graft patency 1
For high cardiovascular risk patients undergoing non-cardiac surgery, the American College of Cardiology recommends continuing aspirin, as trials show an 80% reduction in major cardiac events 3

The standard recommendation is to stop aspirin ≤7 days before surgery, not 7-10 days 1
For neuraxial or closed-space procedures, aspirin should be stopped 5-7 days before surgery 4
Aspirin should be resumed within 24 hours after surgery when adequate hemostasis is achieved, according to the American College of Chest Physicians 1

For patients with bare-metal stents, elective surgery should be delayed for at least 30 days after placement, and dual antiplatelet therapy should be continued if surgery occurs within the first 4-6 weeks, as recommended by the American Heart Association 2
For patients with drug-eluting stents, elective surgery should be delayed optimally for 365 days, but may be considered after 180 days if further complication risk is low, according to the American College of Cardiology 2

Continuing aspirin may increase procedural bleeding frequency, but typically does not increase severity of bleeding complications or perioperative mortality, as stated by the American College of Chest Physicians 3
Perioperative aspirin may increase blood loss but does not increase mortality and is associated with improved bypass graft patency, according to the American Heart Association 3