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J Thromb Haemost. 2015 Jun;13 Suppl 1:S297-303. doi: 10.1111/jth.12975.

Role of aspirin for prevention and treatment of perioperative cardiovascular events.

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Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Department of Medicine, University of Rochester, Rochester, NY, USA.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, ON, Canada.


Among adults undergoing non-cardiac surgery who are at risk of a myocardial infarction, a long-standing question has been whether these patients should receive aspirin throughout the perioperative period. A large (n = 10,010 patients) international trial (POISE-2) demonstrated that perioperative aspirin did not prevent myocardial infarction, and the result was consistent both for patients who had been taking aspirin before the trial (continuation stratum, 4382 patients) and for patients who had not been taking aspirin before the trial (initiation stratum, 5628 patients). Aspirin did, however, increase the risk of major bleeding. Therefore, the best evidence does not support the use of aspirin for the prevention of myocardial infarction in patients undergoing non-cardiac surgery. In patients who have an indication for long-term aspirin usage and have their aspirin held during the perioperative period, it is important to ensure aspirin is restarted after the high-risk period for bleeding has passed (i.e., 8-10 days after surgery).


aspirin; cardiology; cardiovascular diseases; myocardial infarction; perioperative care

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