# Aspirin and surgery: Calling all doctors **URL:** \ **Category:** Factual Questions\ **Created:** [January 21, 2005, 5:03am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871 "2005-01-21T05:03:48Z")\ **Posts on this page:** 8\ **Page:** 1
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [January 21, 2005, 5:03am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/1 "2005-01-21T05:03:48Z")
I’m having shoulder surgery (arthroscopic) in 6 days. I was told not to take aspirin or aspirin products for 1 week prior to the surgery. First, why? What’sup with the aspirin? Second, can I take Tylenol for my splitting headache?? ---
**Author:** ![InternetLegend](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/internetlegend/32/13154_2.png) [@InternetLegend](https://boards.straightdope.com/u/InternetLegend)\ **Post date:** [January 21, 2005, 5:06am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/2 "2005-01-21T05:06:32Z")
Aspirin has anticoagulant properties, so you shouldn’t take it before any activity that involves bleeding. Tylenol doesn’t have those properties, so it should be all right. (I’m not a doctor, I just give blood regularly and I’ve had a few surgeries.) ---
**Author:** ![Tapioca\_Dextrin](https://avatars.discourse-cdn.com/v4/letter/t/3d9bf3/32.png) [@Tapioca\_Dextrin](https://boards.straightdope.com/u/Tapioca_Dextrin)\ **Post date:** [January 21, 2005, 5:09am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/3 "2005-01-21T05:09:19Z")
Isn’t this the sort of question you should be asking a doctor? ---
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [January 21, 2005, 5:17am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/4 "2005-01-21T05:17:40Z")
> [@Tapioca Dextrin](#): > > Isn’t this the sort of question you should be asking a doctor? You ever try to get a hold of a doctor at 9pm for a headache? ---
**Author:** ![Epimetheus](https://avatars.discourse-cdn.com/v4/letter/e/c4cdca/32.png) [@Epimetheus](https://boards.straightdope.com/u/Epimetheus)\ **Post date:** [January 21, 2005, 5:34am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/5 "2005-01-21T05:34:46Z")
IANAD, but what **IL** said. Aspirin would not be recommended before a surgery because of its blood thining properties. When cutting into you, it is best not to have blood that likes to flow easier. ---
**Author:** ![picunurse](https://avatars.discourse-cdn.com/v4/letter/p/7bcc69/32.png) [@picunurse](https://boards.straightdope.com/u/picunurse)\ **Post date:** [January 21, 2005, 6:00am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/6 "2005-01-21T06:00:11Z")
Asprin interfers with the normal clotting process. It would cause excessive bleeding. Unless you have liver disease or are drinking alcohol, Tylenol should be ok. ---
**Author:** ![edwino](https://avatars.discourse-cdn.com/v4/letter/e/35a633/32.png) [@edwino](https://boards.straightdope.com/u/edwino)\ **Post date:** [January 21, 2005, 6:19am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/7 "2005-01-21T06:19:48Z")
You should probably also avoid other NSAIDs (ibuprofen, naproxen, Vioxx or Celexa if you still have them around) because those do the same. Although aspirin is supposedly worse because it binds irreversibly to the enzyme where the others bind reversibly. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [January 21, 2005, 6:31am UTC](https://boards.straightdope.com/t/aspirin-and-surgery-calling-all-doctors/285871/8 "2005-01-21T06:31:59Z")
Except for neurosurgical and ocular procedures, there is probably greater risk from blood clotting than there is from bleeding in the perioperative period. For example, virtually all operations increase a person’s risk of heart attacks, strokes, and dangerous blood clots (pulmonary embolism). These are all serious, potentially lethal complications with a frequency of about 5 - 10% in major surgery in the over 65 age group. On the other hand, bleeding, as unpleasant as it is, is unlikely to be fatal. Hence, despite the traditional advice to stop taking aspirin about a week before surgery, it is conceivable that it is better to maintain aspirin therapy in the days before surgery. The above argument is even more intriguing when one notes that the sudden discontinuation of aspirin (such as occurs when someone stops his/her aspirin treatment in anticipation of an upcoming operation) can actually lead to an overshoot or “rebound” in the tendency for blood to clot. Further, surgery and the associated physiologic stresses (increased adrenalin etc) are known to increase the blood’s tendency to clot (this makes sense from an evolutionary perspective - when you’re being chased by a saber tooth tiger, or have fallen from a height, it’s a good thing for your blood to have its clotting ability enhanced). Both these mechanisms would suggest that stopping aspirin before surgery may not be the best idea. Of course, aspirin does more than just “thin” the blood. It is also an anti-inflammatory drug. This is potentially of great importance given the almost exponential growth in the number of studies published in the last five years which indicate the potent role of inflammation in the genesis of heart attacks and strokes. (You may have heard of two such studies recently which showed that levels of markers of inflammation were strong and independent risk factors for heart attacks and death - [study 1](http://content.nejm.org/cgi/content/abstract/352/1/20) and [study 2](http://content.nejm.org/cgi/content/abstract/352/1/29)). Studies looking at the effect of aspirin around the time of surgery are just beginning to be published. [Here is one of the most interesting](http://content.nejm.org/cgi/content/abstract/347/17/1309) (which admittedly didn’t examine _continuous_ aspirin therapy around the time of surgery, but instead looked at _early_ postoperative reintroduction of aspirin (\< 48 hr post-op) compared to later reintroduction of aspirin. Still, an impressive result.) All this being said, the current recommendation is to withhold aspirin therapy for one week before scheduled surgery, and I am not suggesting that anyone should ignore that advice.