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Aspirin Perioperative Management — FRCA Final MCQ

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ModeratePreoperative AssessmentAspirin Perioperative ManagementFRCA Final

A 70-year-old man (ASA III) on aspirin 75 mg daily presents for elective total hip replacement. The orthopaedic surgeon requests aspirin be stopped 7 days pre-operatively. According to current guidelines, what is the recommended approach?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Continue aspirin throughout – do not stop for major joint arthroplasty

Current evidence (POISE-2 trial, ATACAS trial) and guidelines support continuing aspirin through major orthopaedic surgery in patients taking it for secondary prevention (previous MI, stroke, PVD). Stopping aspirin for >5 days is associated with a rebound prothrombotic state and increased cardiovascular events. The bleeding risk from aspirin in hip replacement is minimal and manageable. For primary prevention aspirin, stopping may be considered. Each case requires individual risk-benefit assessment.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and coagulation; NICE – 2023 – NG111 Hip fracture