Is Aspirin “Surgery Safe?”

December 13, 2016

Smilowitz, et al. 2016: Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery

For patients with coronary artery disease undergoing joint and spine surgeries, aspirin use appears to be safe.

Hip, knee, and spine orthopedic surgeries are on the rise, with over 1.5 million of these procedures performed each year in the United States. Older adults are the main group receiving these kinds of surgeries, a group that is also at high risk of cardiovascular events such as heart attacks and strokes. This makes cardiovascular complications after surgery a major concern and source of significant morbidity and mortality in these patients.

Aspirin is an anti-platelet drug which prevents blood clots and heart attacks – but it also increases bleeding. The net benefit of using aspirin to reduce rates of cardiovascular events in at-risk individuals is still under examination. In some studies, aspirin increased rates of major bleeding without reducing cardiac events or all-cause deaths. However, these studies may not have looked specifically at high risk patients, who may benefit more from aspirin use. Few studies have looked at aspirin use, bleeding, and cardiovascular outcomes among high-risk patients undergoing joint and spine surgery.

A new study of adults undergoing knee, hip, and spine surgery was published in the December 2016 edition of the Journal of Clinical Anesthesiology. It looked at the type of surgery, gender, risk factors, history of heart disease, and aspirin use for patients in a large medical center. The study concluded that, in high-risk patients, aspirin use before, during, and after surgery appears to safely reduce the incidence of cardiovascular events. Additional studies are needed to determine the optimal strategies for perioperative cardiovascular risk reduction.

The study can be found Here
Smilowitz, et al. 2016.
Perioperative antiplatelet therapy and cardiovascular outcomes in patients undergoing joint and spine surgery,
Journal of Clinical Anesthesia,, December 2016. Vol. 35, pg 163-169