title: Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome.
abstract: OBJECTIVE
  To provide an evidence-based focused review of aspirin use in the perioperative period along with an in-depth discussion of the considerations and risks associated with its preoperative withdrawal.
  
  
  BACKGROUND
  For patients with established cardiovascular disease, taking aspirin is considered a critical therapy. The cessation of aspirin can cause a platelet rebound phenomenon and prothrombotic state leading to major adverse cardiovascular events. Despite the risks of aspirin withdrawal, which are exacerbated during the perioperative period, standard practice has been to stop aspirin before elective surgery for fear of excessive bleeding. Mounting evidence suggests that this practice should be abandoned.
  
  
  METHODS
  We performed a PubMed and Medline literature search using the keywords aspirin, withdrawal, and perioperative. We manually reviewed relevant citations for inclusion.
  
  
  CONCLUSIONS
  Clinicians should employ a patient-specific strategy for perioperative aspirin management that weighs the risks of stopping aspirin with those associated with its continuation. Most patients, especially those taking aspirin for secondary cardiovascular prevention, should have their aspirin continued throughout the perioperative period. When aspirin is held preoperatively, the aspirin withdrawal syndrome may significantly increase the risk of a major thromboembolic complication. For many operative procedures, the risk of perioperative bleeding while continuing aspirin is minimal, as compared with the concomitant thromboembolic risks associated with aspirin withdrawal. Those cases where aspirin should be stopped include patients undergoing intracranial, middle ear, posterior eye, intramedullary spine, and possibly transurethral prostatectomy surgery.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA. ngerstein@gmail.com
authors.forename: Neal Stuart
authors.initials: NS
authors.lastname: Gerstein
authors.forename: Peter Mark
authors.initials: PM
authors.lastname: Schulman
authors.forename: Wendy Hawks
authors.initials: WH
authors.lastname: Gerstein
authors.forename: Timothy Randal
authors.initials: TR
authors.lastname: Petersen
authors.forename: Isaac
authors.initials: I
authors.lastname: Tawil
mesh_terms: D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000517:prevention & control; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D015580:Mohs Surgery; D019637:Orthopedic Procedures; D019990:Perioperative Care; D059035:Perioperative Period; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D013927:Thrombosis / Q000517:prevention & control; D013520:Urologic Surgical Procedures; D014656:Vascular Surgical Procedures
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin