Key takeaways:
Many people need to take aspirin to prevent heart attacks and strokes. But aspirin changes the way blood clots, and so it can increase the risk of bleeding during surgery.
If you’re going to have surgery, you may need to stop taking your aspirin 1 week beforehand. But this depends on the type of surgery and why you take aspirin.
People who take aspirin for heart disease — especially those who have a heart stent — may need to continue low-dose aspirin before surgery.
Before you stop taking your aspirin, make sure all members of your healthcare team agree. This includes both your surgical and your cardiology teams.
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If you take aspirin on a regular basis, it’s important to know whether you should stop it before an upcoming surgery. Aspirin prevents blood clotting, which can be important for people with certain medical conditions — like heart disease. But this also means it can increase the risk of bleeding complications during surgery.
Deciding whether or not to hold your aspirin comes down to two things: why you take aspirin and what type of surgery you have planned. Let’s break down the details.
Why might you need to stop aspirin before surgery?
Aspirin affects the body in several different ways. But one of the main reasons people take it is to prevent blood clots.
Aspirin 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, people who have narrowed or blocked arteries take aspirin to 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 some people need to hold their aspirin before surgery.
Do you always need to stop aspirin before surgery?
No, you don’t always need to stop taking aspirin before surgery. The decision to stop aspirin before surgery depends on:
The reason you take aspirin
The type of surgery you're having
Reason for taking aspirin
The American Heart Association recommends you continue taking low-dose aspirin before surgery if you have coronary artery disease. This is especially true if you have a heart stent or had a heart attack in the past. Taking aspirin helps prevent a clot from forming inside your stent, which would cause another heart attack. (This is also called “stent thrombosis.”)
If you have any type of heart disease, it’s important to talk to your cardiologist before stopping your aspirin — even if your surgery team tells you to do so. Your surgery team might not know your full heart health history. So they should work closely with your heart team to figure out what’s safest for you.
The same is true if you have a history of stroke, or if you have a stent in your carotid artery. Depending on the surgery, you may need to continue aspirin when having surgery. So it’s important to consult with your neurologist or stroke specialist.
In other cases, it may be safer to stop aspirin before surgery if you take it for:
Heart disease prevention (and have never had heart disease or stroke)
Pain
Type of surgery
The decision to stop aspirin before surgery is also related to the type of surgery you’re having. You may need to stop taking aspirin if you’re having a surgery with a higher risk of heavy bleeding — or a higher risk of complications from bleeding.
Examples of high-risk surgeries include:
Brain surgery
Spinal cord surgery
Major chest or abdominal surgery
Certain eye surgeries (like retinal surgery)
These are just a few examples. The most important point is that each person — with the help of their healthcare team — needs to weigh the risk of stopping aspirin with the risk of bleeding in surgery.
How long should you hold aspirin before your surgery?
If your healthcare team recommends you stop taking aspirin before your surgery, most healthcare professionals recommend stopping aspirin 7 days before surgery. This is because it takes that long for platelets to return to their normal level of function without aspirin.
A note on other medications like aspirin before surgery
Some people with heart disease may take other medications that affect platelets in addition to aspirin. These are called P2Y12 inhibitors. They include:
Clopidogrel (Plavix)
Prasugrel (Effient)
Ticagrelor (Brilinta)
Most people who have had a heart stent procedure within the last year need both aspirin and a P2Y12 inhibitor. This combo of medications is called dual antiplatelet therapy (DAPT), and it’s an important treatment to prevent stent thrombosis.
If you take DAPT, your healthcare team will likely delay any non-emergency surgeries, so you don’t have to stop this treatment. If you do need surgery and are taking DAPT, your healthcare team can do this safely a few different ways with medicines in the hospital.
So, just like aspirin, don’t stop taking your heart medicines unless your cardiologist has been consulted and agrees this is safe for you.
What about taking aspirin after surgery?
If you had to stop taking aspirin before your surgery, your healthcare team may not want you to restart it right away. In some cases, you may be able to start it within 24 hours of your surgery.
In other cases, you may need to wait a few days, especially if you have any bleeding after the surgery. This is because aspirin’s blood-thinning effects start within minutes of taking it again. So you may need to wait until there’s no longer a risk of bleeding before you restart it.
Similar to stopping aspirin before your surgery, the amount of time you’ll need to hold your aspirin after surgery 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
Your healthcare team will give you a specific plan for when it’s safe to restart your aspirin.
Frequently asked questions
Aspirin isn’t the same as other blood thinners like apixaban (Elquis), rivaroxaban (Xarelto), or warfarin (Coumadin). These medications prevent blood clots in different ways than aspirin. Depending on the bleeding risk, you may need to stop them before surgery. But these are considered separate from aspirin, so it’s important to talk to your healthcare team about this.
The only way to stop taking low-dose aspirin safely is with the direction and monitoring of your healthcare team — especially a cardiologist. They can help you understand if it’s risky to stop taking low-dose aspirin. There are also medicines that can help prevent blood clots and stent thrombosis if you need to stop taking low-dose aspirin before surgery.
If your healthcare team recommends it, you can stop taking aspirin abruptly. In other words, you can hold aspirin completely for several days before surgery. But don’t stop taking aspirin suddenly if your cardiologist hasn’t explicitly told you to do so. This can lead to a sudden heart attack.
Aspirin isn’t the same as other blood thinners like apixaban (Elquis), rivaroxaban (Xarelto), or warfarin (Coumadin). These medications prevent blood clots in different ways than aspirin. Depending on the bleeding risk, you may need to stop them before surgery. But these are considered separate from aspirin, so it’s important to talk to your healthcare team about this.
The only way to stop taking low-dose aspirin safely is with the direction and monitoring of your healthcare team — especially a cardiologist. They can help you understand if it’s risky to stop taking low-dose aspirin. There are also medicines that can help prevent blood clots and stent thrombosis if you need to stop taking low-dose aspirin before surgery.
If your healthcare team recommends it, you can stop taking aspirin abruptly. In other words, you can hold aspirin completely for several days before surgery. But don’t stop taking aspirin suddenly if your cardiologist hasn’t explicitly told you to do so. This can lead to a sudden heart attack.
The bottom line
If you take aspirin and need surgery, it’s important to come up with a specific plan about whether you should hold your aspirin. Stopping your aspirin may be dangerous if you have heart disease or a heart stent. And you may only need to stop taking it if you’re having a major surgery like brain surgery. Together, your surgery and cardiology teams can weigh the benefits and risks of stopping aspirin before your surgery. So don’t be shy about bringing together all the members of your healthcare team to make sure everyone agrees on the safest plan for you.
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References
Douketis, J. D., et al. (2022). Perioperative management of antithrombotic therapy: An American College of Chest Physicians clinical practice guideline. CHEST.
Gerstein, N. S., et al. (2020). A comprehensive update on aspirin management during noncardiac surgery. Anesthesia & Analgesia.
Kumbhai, D. J., et al. (2026). Antiplatelet therapy in the management of atherosclerotic cardiovascular disease: 2026 ACC scientific statement: A report of the American College of Cardiology. JACC.
