UBCmed09

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Hello from Canada.

I'm curious to hear what prevailing practice is with regards to perioperative aspirin management in patients who are taking it as secondary prevention (eg. past Hx of stroke). POISE-2 doesn't really help with this question and I can't find good evidence to guide practice on this question. My concern arises from a several patients on ASA with a history of stroke who have been advised by preop RNs to stop their aspirin (without consulting me). These have been patients coming for minor surgery (eg. inguinal hernias).

Are most folk continuing ASA in this population for low bleeding risk surgery? Again, I'm concerned about stroke risk in those with previous events.

Thanks for your thoughts,
UBCmed09
 

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Wiseguy
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It's all about risks. Per the stroke prevention guidelines, aspirin reduces the annual relative risk by only 15% (6-23%). Divide that by 52 and you will get an insignificant number.
 

nap$ter

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Hello from Canada.

I'm curious to hear what prevailing practice is with regards to perioperative aspirin management in patients who are taking it as secondary prevention (eg. past Hx of stroke). POISE-2 doesn't really help with this question and I can't find good evidence to guide practice on this question. My concern arises from a several patients on ASA with a history of stroke who have been advised by preop RNs to stop their aspirin (without consulting me). These have been patients coming for minor surgery (eg. inguinal hernias).

Are most folk continuing ASA in this population for low bleeding risk surgery? Again, I'm concerned about stroke risk in those with previous events.

Thanks for your thoughts,
UBCmed09
do you have pubmed in canada? it's chock full of good evidence on the subject condensed in the following review: :D

Aspirin in the perioperative period: a review of the recent literature.
Kiberd MB, et al. Curr Opin Anaesthesiol. 2015.
 
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UBCmed09

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do you have pubmed in canada? it's chock full of good evidence on the subject condensed in the following review: :D

Aspirin in the perioperative period: a review of the recent literature.
Kiberd MB, et al. Curr Opin Anaesthesiol. 2015.
Your tone is cute but always important to read those articles you pull up on Pubmed (which we do have in Canada) ;). Entering search terms and scanning titles does not constitute a lit search my friend. Yes, I've read that piece, but it simply states what I tried to simplify in my question: we don't have good evidence to guide cessation vs continuation of ASA for non-high bleeding risk procedures. Their summary: "The continuation or discontinuation of ASA perioperatively remains a complicated issue. Further, well designed trials are needed for additional clarification." Hence, why I pose the question. Nice try though ;)

My question stands if anyone cares to share how they manage perioperative ASA in those patients with history of stroke coming for procedures with low-moderate bleeding risk.

Thanks again,
UBCmed09
 
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UBCmed09

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It's all about risks. Per the stroke prevention guidelines, aspirin reduces the annual relative risk by only 15% (6-23%). Divide that by 52 and you will get an insignificant number.
Thanks, I'm familiar with this approach but I'm not convinced these numbers apply to the perioperative period and the so-called aspirin discontinuation syndrome. My concern is that this approach may underestimate the risk.
 

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Wiseguy
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1. Based on your own practice, how many periop strokes have you seen?
2. If a patient comes in after empirically stopping aspirin, will you cancel his/her minor surgery? ;)
 

nap$ter

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Your tone is cute but always important to read those articles you pull up on Pubmed (which we do have in Canada) ;). Entering search terms and scanning titles does not constitute a lit search my friend. Yes, I've read that piece, but it simply states what I tried to simplify in my question: we don't have good evidence to guide cessation vs continuation of ASA for non-high bleeding risk procedures. Their summary: "The continuation or discontinuation of ASA perioperatively remains a complicated issue. Further, well designed trials are needed for additional clarification." Hence, why I pose the question. Nice try though ;)

My question stands if anyone cares to share how they manage perioperative ASA in those patients with history of stroke coming for procedures with low-moderate bleeding risk.

Thanks again,
UBCmed09
aw shucks

i shared the article to point out to you what you apparently already knew - the topic is controversial without strong evidence. the individual practices garnered via your question on this forum will reflect that.

if you haven't already done so searching this forum for historical threads will yield some discussion to support the above.

for what it's worth as i've stated in another thread i always tell any patient on asa to continue their asa perioperatively. if a relatively hi risk pt ie h/o cva or cad or especially stents presents having discontinued asa at the recommendation of anyone i have them take an asa in preop and proceed. surgeons at my institution are willing to go along with this.

consequences of unproven slightly increased risk of periop bleeding on asa <<<<< consequences of (unproven) risk of catastrophic thrombosis - IMHO
 
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dannyboy1

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Surgeons call. There is no contraindication to going under anesthesia while taking ASA ;)
 

vector2

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Are most folk continuing ASA in this population for low bleeding risk surgery? Again, I'm concerned about stroke risk in those with previous events.
Just from an intuitive standpoint, why would we stop ASA for non-high risk bleeding surgery considering we don't stop ASA in vasculopaths even for major vascular surgeries which potentially could have significant bleeding? Granted I'm not well-versed in the evidence, but anecdotally I don't like messing with their previously established homeostatic milieu unless it's going to have significant anesthetic implications (i.e. taking 40mg of lisinopril a couple hours before induction)