Peri-operative aspirin can prevent post-operative ischemia and thrombosis

Of the 30 million patients in the USA who undergo non-cardiac surgery every year, approximately 1.5 million suffer post-operative cardiovascular events. Surgical trauma and associated catecholamine release leads to platelet activation in the immediate post-operative period, as evidenced by a rise in circulating platelet release products. Platelet activation promotes platelet aggregation and hypercoagulability. Aspirin is widely used for its platelet inhibiting effects to prevent myocardial infarction and stroke. However, aspirin is not routinely started in the immediate peri-operative period, and even in high-risk patients already taking aspirin, aspirin is generally discontinued before elective surgery to improve intra-operative hemostasis. The risk-to-benefit ratios of administering vs withholding aspirin in the immediate peri-operative period have never been assessed and compared. We hypothesize that aspirin given pre-, intra- or immediately post-operatively will reduce post-operative ischemia and thrombotic events, including myocardial infarction and stroke, and that risk-benefit analysis would favor the administration of aspirin. This hypothesis can and should be tested in a prospective, randomized trial.