Aspirin Cessation Before Interventional Procedures: Not Blindly Following Guidelines but Making Test-based Decisions
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Published on: March 15, 2022
Kyeong Hwan Seo1, Francis Sahngun Nahm2, Woong Ki Han3
1Keimyung University School of Medicine, South Korea.
Insights
Discontinuing aspirin before procedures may not be necessary, as many patients taking it show normal platelet function. Individual platelet function testing is recommended for personalized decisions regarding aspirin use before interventional pain procedures.
Area of Science:
- Cardiology
- Pain Medicine
- Pharmacology
Background:
- Guideline inconsistencies exist regarding aspirin discontinuation before interventional procedures.
- Individual platelet function is often overlooked in current recommendations.
- Aspirin resistance prevalence is a significant clinical concern.
Purpose of the Study:
- To assess the necessity of aspirin discontinuation before interventional pain procedures.
- To evaluate the role of individual platelet function in this decision.
- To compare platelet function in aspirin-taking versus non-aspirin-taking patients.
Main Methods:
- A multicenter, cross-sectional study involving 1,111 patients.
- Platelet function measured using closure time with collagen/epinephrine cartridges.
- Patients categorized into aspirin-taking (Group A) and non-aspirin-taking (Group N) groups.
Main Results:
- 56.4% of aspirin-taking patients (Group A) exhibited normal platelet function.
- 43.6% of aspirin-taking patients showed abnormal platelet function.
- 85.8% of non-aspirin-taking patients (Group N) had normal platelet function, while 14.2% showed abnormal function.
Conclusions:
- High prevalence of normal platelet function in aspirin users suggests discontinuation may not always be required.
- Abnormal platelet function can occur in both aspirin users and non-users.
- Individual platelet function testing is crucial for personalized decisions on aspirin use prior to interventional procedures.
Background:
Deciding whether to continue or discontinue aspirin prior to interventional procedures is a major concern for pain physicians. Many guidelines have been published on the discontinuation of aspirin before invasive procedures; however, the recommendations are inconsistent and do not consider individual platelet function. Furthermore, many studies have shown a high prevalence of aspirin resistance in patients taking this medication.
Objectives:
To determine the necessity of discontinuing aspirin prior to interventional pain procedures in relation to individual platelet function.
Study Design:
Multicenter, cross-sectional study.
Setting:
University-affiliated hospitals.
Methods:
We examined platelet function among patients scheduled for an interventional pain procedure by measuring their closure time using collagen/epinephrine cartridges in a commercial platelet-function analyzer. The patients were categorized into either an aspirin-taking or nonaspirin-taking group (Group A or Group N, respectively). The proportion of patients who showed normal/abnormal platelet function was calculated and compared between the groups.
Results:
A total of 1,111 patients were included in this study. In Group A, 56.4% (102/181) showed normal platelet function, whereas 43.6% (79/181) showed abnormal platelet function. In Group N, 85.8% (798/930) and 14.2% (132/930) showed normal and abnormal platelet function, respectively.
Limitation:
The proportion of laboratory, not clinical aspirin resistance was evaluated. Factors affecting platelet function were not investigated exhaustively.
Conclusion:
The high prevalence of normal platelet function in patients taking aspirin suggests no necessity of discontinuation before procedures in such patients. Abnormal platelet function can occur even in patients who are not taking aspirin. Therefore, platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors.
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