Aspirin Can Be Safely Stopped Before Non-Cardiac Surgery for Stent Patients, Major Study Finds
A new multicenter study offers critical guidance for the nearly 20% of patients with coronary stents who require surgery unrelated to the heart, revealing that discontinuing aspirin does not significantly increase the risk of major complications.
A comprehensive analysis led by Professor Ahn Jeong-min of Asan Medical Center in Seoul, and spanning data from 30 medical institutions across the country between 2017 and 2024, found no substantial difference in adverse outcomes between patients who continued taking aspirin and those who stopped before undergoing non-cardiac procedures. The study, involving 1,010 patients, showed a 0.6% incidence of death, myocardial infarction, stent thrombosis, and stroke within 30 days of surgery in the group that maintained aspirin therapy, compared to 0.9% in the group that discontinued it.
Ischemic heart disease, a leading cause of death in Korea, is often treated with coronary stents and dual antiplatelet drugs to prevent blood clots. However, patients frequently face a difficult dilemma when scheduled for surgery in other areas – such as abdominal procedures, orthopedic operations, endoscopy, ophthalmology, or even dentistry – within two years of stent placement. The core concern revolves around the potential for increased clotting risk if aspirin is stopped, versus the heightened risk of bleeding if it’s continued.
Current clinical practice guidelines generally recommend continuing aspirin unless the risk of bleeding is exceptionally high. However, a spokesperson noted that in practice, many physicians err on the side of caution and recommend stopping the medication, leading to widespread uncertainty.
This research directly addresses that uncertainty. The study specifically examined patients undergoing surgery at least 12 months after stent insertion, demonstrating that both continuing and discontinuing aspirin were clinically acceptable options. While a slight increase in minor bleeding was observed in patients who continued aspirin, the overall risk of major complications remained comparable between the two groups.
“These findings generate high-quality evidence needed to confidently decide whether to discontinue medications like aspirin when surgery is required in these patients,” stated a senior official involved in the research. The study also highlights the growing importance of shared decision making – a collaborative approach where medical professionals and patients jointly determine treatment plans based on the best available evidence and individual preferences.
The research was supported by the Patient-Centered Medical Technology Optimization Research Group (PACEN), with Professor Ahn Jeong-min serving as principal investigator. The full clinical value evaluation report is available on the PACEN website: https://pacen.neca.re.kr.
This study represents a significant step forward in optimizing patient care and reducing unnecessary anxiety surrounding perioperative medication management for individuals with coronary stents.
