“Couldn’t we still do the procedure?” he asked. “After all, I would be stopping 4 days ahead of surgery, rather than 7 days.”

Last Monday I got an unexpected break. A close friend had decided to have surgery in our clinic, but then took aspirin four days before the procedure and had to reschedule.

Luckily, this rarely happens. We typically see all patients two weeks before surgery and instruct them to stop aspirin. However, this patient is a friend who was too busy to come in early. He had had other surgeries in the past and had talked to me about the details of this procedure “socially”. So when he decided to go to Hawaii before surgery and come in for his pre-operative appointment just 4 days prior his procedure, I agreed. Surely he knew to stop aspirin (and I must have told him at the last party?).

At his pre-operative appointment, four days before surgery, all seemed well. But after he got home from the appointment, he realized that his daily “vitamins” contained aspirin, and he had taken them that day. “Couldn’t we still do the procedure?” he asked. “After all, I would be stopping 4 days ahead of surgery, rather than 7 days.” He is a very busy man and had rearranged his whole schedule for this procedure; changing it again would not be easy. Should I make an exception for my friend? Hmmm.

So I hit the internet for a quick medical update – do you really have to stop aspirin before you have surgery – or any invasive procedure? In our clinic that has always been the rule. Aspirin works by inhibiting platelet function – it makes your blood clot less easily. The effect on platelets is irreversible, but your body fully replaces all the platelets every 7-10 days. So if you stop aspirin 10 days before your procedure, your clotting ability should be back to normal.

But what if you forget to stop your aspirin and have surgery? As more and more people take aspirin daily, this is a common question and there is actually some data on the subject. Aspirin clearly makes it so you take longer to stop bleeding, but you still stop. Oral surgery patients on aspirin do not appear to have any higher rate of complications from surgery, so now many oral surgeons do not require patients to stop aspirin. In fact, if a patient is at high risk for strokes or heart attacks, patients are encouraged to continue the aspirin. Orthopedic surgeons are also noting “no increase in complication” with patients on aspirin. In fact the only holdouts seem to be neurosurgeons and cosmetic surgeons – where a little increased bleeding can matter.

It terms of cosmetic procedures, the main concern is increased bruising. The long term results are probably not altered by taking aspirin – so aspirin may not cause serious complications. But increased bruising may be the difference between going back to work in seven days versus 14 days. And if you get bleeding under the skin after eyelid surgery, it may mean a trip back to surgery to remove the clots. I personally notice that patients who don’t stop aspirin bruise significantly more after injections. So in our clinic we still enforce the no aspirin for a week before surgery policy, unless patients are at high risk for strokes.
My friend is not at high risk for strokes, and just takes aspirin as a preventive measure because of his age and family history. But while he may not have had a serious complication, I wanted him to have a great experience and result. After discussing the situation with him, we both agreed to reschedule surgery for the following week. Surprisingly, he was able to adjust his appointments. And I could feel that I was giving him the best care possible – even if we were erring on the side of caution.