When should aspirin be stopped before non cardiac surgery?

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For patients taking aspirin for primary or secondary prevention of cardiovascular disease, one should stop aspirin seven days before noncardiovascular surgery.

The best evidence regarding the impact of aspirin on outcomes comes from the POISE–2 trial in which 10,010 patients scheduled for noncardiac surgery, with or at risk of atherosclerotic disease, were randomly assigned to either aspirin or placebo.

The primary outcome of death or nonfatal heart attack at 30 days was similar in both groups as well as between those who were taking long–term aspirin and those who were not. As expected, major bleeding was more common in the aspirin group.

Based on POISE–2, the recommendation is to stop aspirin about seven days before noncardiovascular surgery.