Aspirin-Induced Prolongation of Bleeding Time and Perioperative Blood Loss

Abstract

One hundred twenty-nine patients undergoing total hip replacement were treated with aspirin at a level of either 300 mg four times a day (1.2 g/day) or 900 mg four times a day (3.6 g/day). Baseline bleeding times before aspirin treatment averaged 4.18 +/- 1.44 minutes. Two hours after 300 mg and 900 mg of aspirin, the bleeding times were 5.83 +/- 1.88 and 5.72 +/- 1.57 minutes, respectively. After three to five days of aspirin therapy at 1.2 g/day and 3.6 g/day, the bleeding times were 6.27 +/- 2.27 and 6.43 +/- 2.11 minutes, respectively. The bleeding times for all the aspirin-treated groups were longer than baseline times. No paradoxical shortening of the bleeding time was noted at the 3.6-g/day dose. Perioperative blood loss for those receiving aspirin was not increased in six of eight subsets by operation and anesthesia when compared with historical control subjects. Neither a bleeding time greater than ten minutes nor a prolongation of the bleeding time by aspirin of more than four minutes over baseline bleeding times was associated with increased perioperative blood loss.

Outcome of Aspirin Use During Excision of Cutaneous Lesions

“…2 A correlation between the bleeding time and rate of bleeding complications has not been established in a variety of surgical conditions. 13,18,19 Dosages between 150 and 300 mg, as used by the patients in this series, exerts an antiplatelet effect and others have presumed that the pharmacological effect is similar in this dose range. 1 Recommendations for timing the discontinuation of aspirin before surgery have been questioned.…”

Regular aspirin use and gene expression profiles in prostate cancer patients

“…We do not know whether they continued aspirin up until the day of surgery. Higher periprocedural bleeding risks from aspirin were known during the study period [38, 39]. It is therefore likely that most patients discontinued aspirin for several days before undergoing prostate biopsy or prostatectomy.…”

A Critical Reappraisal of the Bleeding Time

“…Orthopaedic surgery patients, premedicated with aspirin, showed no correlation between bleeding time and blood loss. 218 In a study of 101 consecutive (predominantly thyroid and abdominal) surgical procedures, two hematologists, unaware of the preoperative diagnosis, used a battery of tests of hemostasis to classify patients as having a low, intermediate, or high risk of bleeding. 219 An abnormal bleeding time was responsible for the classification of seven of the eight subjects considered to be at high risk.…”