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Aspirin Before Elective Surgery-Stop or Continue?

Lili Plümer1, Moritz Seiffert, Mark Andree Punke

  • 1Department of Anesthesiology, Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Department of General and Interventional Cardiology, University Heart Center Hamburg (UHZ), Hamburg, Germany; Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.

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Summary
This summary is machine-generated.

Stopping aspirin before noncardiac surgery poses risks, especially for patients with coronary stents. Decisions to stop aspirin are influenced by factors like prior stent placement and bleeding concerns, highlighting a gap between guidelines and practice.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Clinical Practice Research

Background:

  • Cessation of long-term aspirin therapy before noncardiac surgery increases cardiac event risk in high-risk patients.
  • Patients with prior percutaneous coronary interventions (PCI) and stent implantation are particularly vulnerable.
  • Factors influencing the decision to discontinue aspirin preoperatively are not well understood.

Purpose of the Study:

  • To identify factors associated with the decision to stop long-term aspirin treatment before noncardiac surgery.
  • To explore patient and anesthesiologist perspectives on preoperative aspirin use.

Main Methods:

  • A single-center, cross-sectional study surveyed 805 patients on long-term aspirin and their anesthesiologists.
  • Standardized questionnaires assessed preoperative aspirin use, comorbidities, and risk-benefit assessments.
  • Multivariable logistic regression and intraclass correlations were used to analyze data.

Main Results:

  • 46.8% of patients stopped aspirin pre-surgery, with many discontinuing at suboptimal times.
  • Prior PCI with stent implantation reduced the likelihood of aspirin cessation (OR=0.47).
  • Factors increasing cessation included prior discontinuation, bleeding risk, lack of understanding of aspirin's purpose, and short time to surgery.

Conclusions:

  • Significant discordance exists between clinical guidelines and actual practice regarding aspirin cessation in patients with coronary stents.
  • Early collaboration between cardiologists and anesthesiologists is crucial.
  • Wider use of stent implant cards could improve guideline adherence.