What You Need to Know About Stopping Aspirin Before Surgery

If you take aspirin on a regular basis, you may need to stop taking it before a planned surgery or procedure. Aspirin has blood-thinning properties, which can be helpful for people who have cardiovascular disease. But this also means it can increase bleeding during surgery. Preparing for surgery can be stressful, so we’ll review what you need to know about taking aspirin before surgery, including when to stop it.

Why do providers recommend stopping aspirin before surgery?

Aspirin has many different effects on the body. For example, it prevents platelets from sticking together. Platelets play a key role in forming blood clots — the same clots that can cause a heart attack or stroke. So if you have cardiovascular disease or are at high risk for developing it, aspirin can help prevent the blockages that cause these problems. 

But the blood-thinning-benefits of aspirin can be risky if you’re having surgery because it can increase your chance of bleeding. This is why healthcare providers may recommend stopping aspirin before surgery.

Do you always need to stop aspirin before surgery?

Whether you need to stop taking aspirin before surgery depends on two things:

• The reason you’re taking it 

• The type of surgery you're having

Some surgeries have a higher risk of bleeding than others. For example, cataract surgery has a low risk of bleeding. Abdominal surgery, on the other hand, has a higher risk of bleeding. So you may not need to stop taking aspirin if you’re having a surgery that does not tend to cause much bleeding. 

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If you’re having a surgery with a higher risk of bleeding, this needs to be balanced with your risk of stopping the aspirin. If you’re taking aspirin because you have cardiovascular disease, it may be safer for you to keep taking the aspirin before surgery. This is because continuing to take the aspirin may prevent heart problems from developing during and after the surgery.

But, in many cases, it may be safer to stop the aspirin before surgery. This is more likely if it’s a major surgery with a high risk of bleeding. This is especially true for people who take aspirin for:

• Cardiovascular disease prevention (and have never had heart disease or stroke)

• Pain or headaches

• Fever

When should you stop taking aspirin before your surgery?

If you take aspirin to prevent cardiovascular disease, providers usually recommend stopping aspirin 7 to 10 days before surgery. This is because it takes that long for platelets to return to their normal level of function without aspirin.

If you have cardiovascular disease and need to stop aspirin, the research is less clear on when to stop it. It also depends on which treatment(s) you’ve had for heart disease. For example, in people who recently had a cardiac stent placed, it’s better to keep taking aspirin. But, if it does need to be stopped, it should be at least 5 days before the surgery.

Some people with cardiovascular disease may take aspirin in addition to another blood-thinning medication that affects platelets — like clopidogrel (Plavix) or ticagrelor (Brilinta). This is dual antiplatelet therapy (DAPT), and it’s common in people with recent cardiac stent placement. If you take DAPT, you may need to stop one or both of the antiplatelet medications before surgery. 

It’s also important to know that aspirin is not the same as other blood thinners like warfarin (Coumadin) or newer, direct-acting oral anticoagulants like rivaroxaban (Xarelto). These medications thin the blood in different ways than aspirin. Depending on the bleeding risk, you may need to stop them before surgery. But these are considered separately from aspirin, so be sure to talk with your provider. 

What about taking aspirin right after surgery?

If you stopped taking aspirin before your surgery, your provider may not want you to restart it right away. Similar to stopping aspirin before your surgery, the amount of time you’ll need to hold your aspirin afterward will depend on:

• The type of surgery you had

• How much bleeding you had during the surgery

• Your risk of bleeding after the surgery

• The reasons you take aspirin

In some cases, you may be able to start it within 24 hours of your surgery or procedure. In other cases, you may need to wait a few days, especially if you have any bleeding after the surgery. This is because once you restart the aspirin, its blood-thinning effects happen within minutes of taking it again. So your provider may want you to wait until there is no longer a risk of bleeding before you restart it. 

Be sure to clarify exactly when you should restart your aspirin with your provider before you go home.

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Written by:

Sarah Pozniak, MD

Sarah Pozniak, MD, has 9 years of experience since graduating medical school (6 since completing residency). She is a board-certified general internal medicine physician and has practiced as a primary care physician in both Utah and Washington, D.C. Currently, she cares for patients with chronic illnesses such as diabetes and high blood pressure using telemedicine as part of a virtual care program.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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