Perioperative use of lowdose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease  Lowdose aspirin induces an irreversible inac

Perioperative use of lowdose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease Lowdose aspirin induces an irreversible inac - Description

There is no absolute consensus about whether or not lowdose as pirin should be continued perioperatively The risk of haemorrhage must be ba lanced against the risk of predisposing the patient to a thromboembolic compli cation such as a coronary even ID: 36647 Download Pdf

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Perioperative use of lowdose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease Lowdose aspirin induces an irreversible inac

There is no absolute consensus about whether or not lowdose as pirin should be continued perioperatively The risk of haemorrhage must be ba lanced against the risk of predisposing the patient to a thromboembolic compli cation such as a coronary even

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Perioperative use of lowdose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease Lowdose aspirin induces an irreversible inac




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Presentation on theme: "Perioperative use of lowdose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease Lowdose aspirin induces an irreversible inac"— Presentation transcript:


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Perioperative use of low-dose aspirin The following guidance was published in a review of perioperative medication in patients with cardiovascular disease (1): Low-dose aspirin induces an irreversible inactivati on of platelet cyclooxygenase, which lasts the lifetime of the platelet (seven to 10 days on average). There is no absolute consensus about whether or not low-dose as pirin should be continued perioperatively. The risk of haemorrhage must be ba lanced against the risk of predisposing the patient to a thromboembolic compli cation, such as a coronary event, transient

ischaemic attack or stroke. Report s of myocardial infarction following cessation of aspirin before coronary artery bypass graft surgery, suggest that aspirin should not be stopped. It is uncommon for serious complications to occur i n patients taking aspirin during the perioperative period, though surgical blood loss is increased. It is sensible to withdraw aspirin in patients whose risks of postope rative bleeding are high. Patients undergoing transurethral prostatectomy have been fo und to have significantly increased perioperative bleeding if aspirin is cont inued and so, for these

patients, aspirin is usually discontinued 7 - 10 days pre-ope ratively; other examples include patients undergoing retinal, major orthopaedic or i ntracranial surgery. Patients undergoing minor surgery do not need to stop aspiri n. A review of bleeding risks associated with aspirin was carried out on 49,590 patients (14,981 taking aspirin). The baseline frequency of bleeding complications varied from 0% (skin lesion excision, cataract surgery) to 75% (transrectal prostate biopsy). Whilst aspirin increased the rate of bleeding compl ications by a factor of 1.5, it was not associated with more

severe bleeding complicati ons (with the exceptions of intracranial surgery, and possibly transurethral pr ostatectomy). The reviewers concluded that low-dose aspirin should be discontin ued prior to surgery only if the risk of bleeding and increased mortality or sequela e was comparable with the increased cardiovascular risk associated with aspir in withdrawal, (2). Patients taking aspirin may also be at an increased risk of haematoma formation with spinal or epidural anaesthesia. There are reports s howing the safety of regional anaesthesia in patients receiving aspirin or other NSAIDs but

the clinical significance of this is of considerable debate and some anaesthe tists may wish to avoid this practice. If stopped, aspirin is usually restarted when diet returns to normal. Following transurethral prostatectomy aspirin is sometimes wi thheld for one week. References: 1. Rahman MH, Beattie J. Peri-operative medication in patients with cardiovascular disease. Pharm J 20 Mar 2004;272(7291):352-354 2. Burger, et al. Low-dose aspirin for secondary ca rdiovascular prevention - cardiovascular risks after its perioperative withdr awal versus bleeding risks with its continuation - review

and meta-analysis. J Intern. Med 2005;257:399-414. Updated November 2005