Aspirin should be held preoperatively in those already receiving it, but it should not be initiated to prevent thrombotic events. (Image source: Thinkstock)

Aspirin should be held preoperatively in those already receiving it, but it should not be initiated to prevent thrombotic events. (Image source: Thinkstock)

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Aspirin constitutes important lifelong therapy for many patients with cardiovascular (CV) disease or significant CV risk factors. However, perioperative aspirin management (continuation versus temporary cessation) in patients undergoing noncardiac surgery is a common clinical conundrum that balances aspirin’s potential for decreasing thrombotic risk against possible increased perioperative blood loss. Dr. Neal Stuart Gerstein, Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico, and colleagues conducted a focused review of aspirin’s role in CV disease and examined the pertinent literature related to perioperative aspirin management, including an appraisal of the POISE-2 trial results. Their review is published in this month’s issue of Anesthesia & Analgesia in the article titled “Perioperative Aspirin Management After POISE-2: Some Answers, but Questions Remain.”

POISE-2 suggests that aspirin administration during the perioperative period does not change the risk of a CV event and may result in increased bleeding. However, these findings are tempered by a number of POISE-2 methodological issues. Based on the currently available literature including POISE-2, the authors recommend that aspirin should not be administered to patients undergoing surgery unless there is a definitive guideline-based primary or secondary prevention indication. However, for patients taking lifelong aspirin for a definitive guideline-based primary or secondary indication, aspirin should likely be continued throughout the perioperative period unless the patient is undergoing a closed-space procedure (i.e., intracranial or middle ear), intramedullary spine surgery, or possibly prostate surgery.