Peri-op aspirin:

 

Pros and cons:

Stopping pros

Stopping cons

Less bleeding

Peri-op hypercoagulability

 

Aspirin withdrawal syndrome

 

Rules:

Primary prevention

 

   Soft

Stop

   Hard

Stop if bleeding risk > MACE risk*

Secondary prevention

 

   Stable

Stop if bleeding risk > MACE risk*

   Previous ACS

Continue DAPT if <1 year^

   BMS

Continue DAPT if <4/52^

   DES

Continue DAPT if <6/12^

 

Qualifiers:

*Bleeding > MACE

·      Brain

·      Spine

·      Eye

·      TURP

^Stent thrombosis risk

Stent:

·      Multiple

·      Narrow

·      Long

·      Bifurcated

Patient:

·      Prev stent thrombosis

·      Diffuse coronary disease

·      ACS presentation

·      Diabetes

·      Heart failure

·      CKD

 

>>>Discuss with cardiology*

>>>Ideal duration of DAPT is still not clear*