Can Aspirin Be Paused Perioperatively in Patients with Coronary Stents Undergoing Low-Risk Surgery?

Kang DY, Lee SH, Lee SW, et al. Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients with Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery. J Am Coll Cardiol. 2024; in press.

Current clinical practice guidelines recommend continuation of aspirin preoperatively and postoperatively in patients with drug-eluting coronary artery stents (DES) who are scheduled to undergo major non-cardiac surgical procedures.

The authors noted that evidence to support this recommendation is limited, and they designed a prospective randomized study that compared outcomes in patients who had continuation of aspirin with patients in whom aspirin was discontinued 5 days prior to operation and restarted within 48 hours of the procedure.

All patients had received DES 1 year or more prior to entry into the study. The primary outcomes of interest were rates of mortality, myocardial infarction, stent thrombosis, or stroke between 5 and 30 days after the procedure. Rates of major and minor bleeding events were also recorded.

The data analysis showed that the primary outcomes occurred infrequently and in similar proportions of the two comparison groups (0.6% of the aspirin group and 0.9% of the control group). There were no instances of stent thrombosis; the rate of minor bleeding events was significantly higher in the aspirin continuation group.

The authors concluded that pausing aspirin perioperatively did not increase the risk for adverse events and might reduce the risk for minor bleeding; they cautioned, however, that the number of high-risk surgeries was low in both groups, and, for this reason, the results need to be interpreted with caution.