Should More Patients Continue Aspirin Therapy Perioperatively?

Abstract

Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.

The Impact of Antiplatelet Medication on Hand and Wrist Surgery

“…[18][19][20] Within orthopedics, aspirin use has not been found to negatively impact mortality or major complications during total hip arthroplasty, femoral neck surgery, or spine surgery despite some evidence of greater local bleeding. [21][22][23][24] Our data suggest that hand and wrist surgery, which involves minimal dissection through muscle, largely falls into a low-risk surgical category amenable to continuation of antiplatelet therapy.…”

Continuous Low-Dose Aspirin Therapy in Robotic-Assisted Laparoscopic Radical Prostatectomy Does Not Increase Risk of Surgical Hemorrhage

“…Therefore, on the basis of the present evidence, although most trials regarding this issue have been observational and retrospective, perioperative continuation of aspirin has become increasingly supported in different medical fields. 4,20 Previously, a retrospective analysis of patients undergoing open radical retropubic prostatectomy in 1990 detected a higher risk for bleeding in 52 aspirin-treated patients. 21 Because of ambiguous data about the safety of transurethral resection of the prostate (conventional electroresection), the recommendations for prostate surgery do not provide definite advice.…”

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

“…S32 patients ayant interrompu leur traitement par aspirine durant la période postopératoire immédiate et dans le mois suivant [25,30,60,64,65,102,103,112,116,127,214,277]. Dans une méta-analyse [40], l'arrêt de l'aspirine chez un patient sous aspirine au long cours est associé une augmentation du risque d'évènement thrombotique (cardiaque ou neurologique) d'un facteur trois (OR 3,14 , IC à 95 % de 1,75 à 5,61, p < 0,05).…”