title: Perioperative aspirin management after POISE-2: some answers, but questions remain.
abstract: Aspirin constitutes important uninterrupted lifelong therapy for many patients with cardiovascular (CV) disease or significant (CV) risk factors. However, whether aspirin should be continued or withheld in patients undergoing noncardiac surgery is a common clinical conundrum that balances the potential of aspirin for decreasing thrombotic risk with its possibility for increasing perioperative blood loss. In this focused review, we describe the role of aspirin in treating and preventing cardiovascular disease, summarize the most important literature on the perioperative use of aspirin (including the recently published PeriOperative ISchemic Evaluation [POISE]-2 trial), and offer current recommendations for managing aspirin during the perioperative period. POISE-2 suggests that aspirin administration during the perioperative period does not change the risk of a cardiovascular event and may result in increased bleeding. However, these findings are tempered by a number of methodological issues related to the study. On the basis of currently available literature, including POISE-2, aspirin should not be administered to patients undergoing surgery unless there is a definitive guideline-based primary or secondary prevention indication. Aside from closed-space procedures, intramedullary spine surgery, or possibly prostate surgery, moderate-risk patients taking lifelong aspirin for a guideline-based primary or secondary indication may warrant continuation of their aspirin throughout the perioperative period.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico; Knight Cardiovascular Institute, Department of Medicine, Oregon Health and Science University, Portland, Oregon; and Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Neal Stuart
authors.initials: NS
authors.lastname: Gerstein
authors.forename: Michael Christopher
authors.initials: MC
authors.lastname: Carey
authors.forename: Joaquin E
authors.initials: JE
authors.lastname: Cigarroa
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schulman
mesh_terms: D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin