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Aspirin and Neuraxial Safety — FRCA Final MCQ

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EasyRegional AnaesthesiaAspirin and Neuraxial SafetyFRCA Final

A 58-year-old man (ASA III) is undergoing a Whipple procedure. The surgical team request an epidural for postoperative analgesia. The pre-operative coagulation screen shows: PT 14.5s (normal 12-15), APTT 32s (normal 24-38), platelets 185, fibrinogen 3.2 g/L. He takes aspirin 75 mg daily. Is neuraxial blockade safe?

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Correct answer: C — Yes – all coagulation parameters are within normal limits and aspirin at 75 mg is NOT a contraindication

All coagulation parameters are within normal limits: PT 14.5s (within range), APTT 32s (normal), platelets 185 (>80 threshold), fibrinogen 3.2 g/L (>1.0). Aspirin at standard prophylactic/antiplatelet doses (75-150 mg) is NOT a contraindication to neuraxial blockade according to the Association of Anaesthetists (2013) and ESRA/ASRA guidelines. Aspirin does impair platelet function but the residual haemostatic mechanisms provide adequate protection against epidural haematoma. Only dual antiplatelet therapy (aspirin + clopidogrel/ticagrelor) or anticoagulant combinations increase risk significantly.

Reference: Association of Anaesthetists – 2013 – Regional anaesthesia and coagulation; RCOA – 2023 – Regional module