Aspirin Should Not Be Stopped Perioperatively, from Medscape

Olongapo City, Philippines by Zero Mella MD — It’s still a popular belief of IM consultants that aspirin should be stopped 7 to 9 days before surgery. The belief is that it may cause increase bleeding risk especially in major abdominal surgeries. Some old cardiologists still adhere from this belief. A medscape article tells us that they may be doing more harm than good.

A phenomenon termed aspirin withdrawal effect causes platelet rebound and prothrombosis which could lead to a cardiovascular event with a mean onset at 11 days from stopping the aspirin.

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Although the literature “strongly supports” that aspirin should be continued preoperatively, a new trial hopes to elucidate the matter regarding aspirin use before surgery. The study is called the POISE-2 trial and the first phase showed a good safety profile pre-operatively. The researchers are unanimous in continuing the study.

“…there was no increase in cardiovascular events in patients who had aspirin held preoperatively.” – Dr Deveraux, POISE-2

There were exceptions noted in the medscape article regarding aspirin continuation. Operations involving the middle ear, posterior chamber of the eye, intracranial, intramedullary spine, and TURP confers the highest risk for a complicating hemorrhage during receipt of aspirin therapy. It is advised to stop aspirin in these procedures for at least 3 days.

Other salient points in the article states that ACP, ACA, ADA, ACCP, and ACC (all american bodies of cardiovascular and diabetes health) recommends uninterrupted use of aspirin perioperatively. There is no change in transfusion requirements for operations with increase in blood loss. The net benefit of aspirin continuation is seen more clearly in high-risk patients.

Here in the Philippines, we still have biases and qualms among respected consultants and specialists that aspirin discontinuation preoperatively is still practiced. It may still take some years and probably the completion of the POISE-2 trial to convince a revision of current practice guidelines.

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