Aspirin Can Be Used Safely Even During Major Surgery

A new study shows that patients undergoing major pancreas operations can continue taking perioperative aspirin through the morning of surgery, with no increased risk of bleeding.

Researchers at Thomas Jefferson University Hospitals (Philadelphia, PA, USA) conducted a retrospective study involving 1,017 patients undergoing pancreatoduodenectomy, distal pancreatectomy, or total pancreatectomy between October 2005 and February 2012. A query revealed that 289 (28.4%) were kept on aspirin through the morning of surgery. The postsurgical results showed that estimated blood loss during surgery, aspirin versus no aspirin, blood transfusion any time during the index admission, and the postoperative duration of hospital stay (median 7 days) was similar between the two groups.
The results also showed that the aspirin group had a slightly increased rate of cardiovascular (CV) complications, which may reflect the health problems related to the initiation of aspirin therapy. Rates of pancreatic fistula and hospital readmissions were similar between the two groups. The researchers concluded that aspirin therapy is not associated with increased rates of perioperative bleeding, transfusion requirement, or major procedure-related complications after elective pancreatic surgery. The study was published on July 26, 2013, in Surgery.

“These data are compelling, so we have changed our practice for the better. We no longer instruct our patients to discontinue taking aspirin prior to these major pancreas operations,” said senior author Charles Yeo, MD. “The prior practice of instructing patients to stop their aspirin five to 10 days prior to surgery should be abandoned. It is safe to perform major pancreas surgery in patients taking aspirin, and stopping aspirin may be dangerous.”

Antiplatelet therapy with aspirin is prevalent among patients presenting for operative treatment of pancreatic disorders. Current operative practice has called for the cessation of aspirin 7–10 days before elective procedures because of the perceived increased risk of procedure-related bleeding. However, many patients also suffer from CV disease, the number one cause of death in the United States, for whom the cessation of treatment with antiplatelet therapy could be dangerous.

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