A Comprehensive Update on Aspirin Management During Noncardiac Surgery

Area of Science:

• Cardiology
• Pharmacology
• Perioperative Medicine

Background:

• Aspirin is a widely used medication for established cardiovascular disease (CVD).
• Its role in primary prevention is increasingly questioned.
• Perioperative aspirin management in non-cardiac surgery presents significant practice variability and uncertainty.

Purpose of the Study:

• To provide an evidence-based update on perioperative aspirin management.
• To offer recommendations for clinicians on continuing versus holding aspirin during non-cardiac surgery.
• To address the conflicting data and lack of unified guidance.

Main Methods:

• Comprehensive literature search of PubMed and Medline.
• Keywords included: aspirin, aspirin withdrawal, perioperative, coronary artery disease, cerebrovascular disease, peripheral artery disease, CV disease.
• Manual review of relevant citations for inclusion.

Main Results:

• Patients for primary prevention should likely discontinue aspirin perioperatively, particularly with high bleeding risk.
• Patients with established CVD without coronary stents should likely continue aspirin, except for closed-space surgery.
• Patients with coronary stents likely need aspirin continuation for non-closed space procedures.

Conclusions:

• Perioperative aspirin management necessitates balancing cessation risks against continuation benefits.
• A patient-specific strategy is crucial.
• Current guidance is conflicting, but guidelines and trial findings offer a framework for decision-making.