Perioperative Management of Aspirin

Introduction to Aspirin Management

• The American Society of Anesthesiologists recommends stopping aspirin 3-5 days before surgery, but for high-bleeding-risk surgeries, stopping 5 days before is safest 1

Surgery Type-Based Aspirin Discontinuation

• For high-bleeding-risk surgeries like neurosurgery, aspirin should be stopped 5 days before surgery 1, 2
• For most surgeries, stopping aspirin 3 days before is sufficient because platelet function improves significantly 1, 2
• For cardiac surgery, such as coronary artery bypass graft (CABG), aspirin should be stopped 5 days before surgery 3, 4

Special Considerations

• For patients with drug-eluting stents, surgery should be avoided within 12 months of stent placement, and if necessary, thienopyridines should be stopped 5 days before, but aspirin should be continued 5, 6
• When using P2Y12 inhibitors in combination, clopidogrel and ticagrelor should be stopped at least 5 days before surgery, and prasugrel should be stopped at least 7 days before 3, 4

Resuming Aspirin After Surgery

• Aspirin should be resumed 12-24 hours after surgery, when adequate hemostasis is achieved 6, 2

Precautions and Important Points

• Aspirin has an irreversible effect on platelets, which lasts 7-10 days, but full platelet function recovery is not necessary for hemostasis, so 3-5 days is sufficient for most surgeries 1, 2
• In patients with high thrombotic risk (such as those with recent stent placement), aspirin should not be stopped without consulting a cardiologist 2
• Aspirin with heparin bridging may increase the risk of bleeding without clear benefits 2