"It appears that operating on aspirin appears to be safe," Dr. Pfeifer said. Exceptions include intracranial procedures and surgery on the medullary canal of the spine; posterior eye chamber; and non-laser transurethral resection of the prostate.
In terms of perioperative dose, the best available evidence suggests no benefit to increasing aspirin dose above 100 mg for most patients, Dr. Pfeifer said (JAMA 2007;297:2018-24).
And dose increases mean increased risk of bleeding as well, he added.
"It seems reasonable to use 81 mg as your perioperative dose, and then to give them a higher dose after that," Dr. Pfeifer said. "The old saying of an aspirin a day keeps the doctor away does not apply to the surgeon."
More definitive answers could come from POISE-2 (PeriOperative ISchemic Evaluation Trial), which is currently enrolling participants with a goal of including 10,000 patients, Dr. Cohn said. Researchers aim to compare patients taking clonidine, aspirin, both, or neither. The results are scheduled for release in 2014.
Dr. Jaffer is a medical advisor to Hospitalist News. Dr. Jaffer, Dr. Cohn, and Dr. Pfeifer had no relevant disclosures.