Balancing bleeding and clotting risks during surgery

Stopping Antiplatelets Before Surgery: Is It Really Worth the Risk?

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"New research questions the long-held practice of halting antiplatelet therapy before non-cardiac surgeries, urging patients and doctors to weigh potential bleeding and clotting risks carefully."

If you're scheduled for surgery and take antiplatelet medications like aspirin or clopidogrel, you've probably heard the standard advice: stop taking them a few days beforehand. The reason? These drugs, crucial for preventing blood clots in people with heart conditions, also thin the blood, potentially leading to excessive bleeding during and after surgery.

This practice, aimed at minimizing bleeding risks, has been a cornerstone of surgical planning for years. However, emerging evidence is causing experts to rethink this approach. What if stopping these medications isn't as beneficial as we thought, or worse, what if it actually increases the risk of dangerous blood clots?

A recent comprehensive review has turned conventional wisdom on its head, suggesting that the decision to continue or discontinue antiplatelet therapy before surgery may not significantly impact the risk of bleeding and could even elevate the risk of life-threatening clots. Let's dive into this game-changing research and explore what it means for you.

The Antiplatelet Paradox: Balancing Bleeding and Clotting Risks

Balancing bleeding and clotting risks during surgery

Antiplatelet drugs are essential for preventing dangerous blood clots in people with a history of heart attack, stroke, or stent placement. They work by inhibiting the ability of platelets to clump together and form clots. While this is life-saving in preventing heart attacks and strokes, it presents a challenge when surgery is needed. The dilemma is simple: how do you balance the risk of bleeding during surgery with the risk of a clot forming if the medication is stopped?

Traditionally, surgeons and doctors have leaned towards stopping antiplatelet medications to reduce the chances of excessive bleeding, a move that made intuitive sense. However, this approach isn't without its own dangers. When antiplatelet drugs are halted, even for a short period, the risk of a thrombotic event like a heart attack or stroke increases, particularly in patients with cardiac stents.

Myocardial Infarction and Acute Coronary Syndromes: Recommended for individuals post-heart attack or with unstable angina.
Coronary Stents: Crucial to prevent clots from forming within the stent, especially in the initial months after placement.
Stroke and Transient Ischemic Attack (TIA): Used to reduce the risk of further strokes by preventing clot formation in the brain's blood vessels.

This creates a challenging paradox: acting to prevent one risk (bleeding) may inadvertently increase another (thrombosis). The latest research attempts to untangle this conundrum and provide clearer guidance.

What It Means for You: A New Era of Personalized Medicine

The most important takeaway from this analysis is that there isn't a one-size-fits-all answer. The decision to continue or discontinue antiplatelet therapy before surgery needs to be a highly individualized one, made in close consultation with your doctor and surgeon. Factors to consider include your specific cardiac history, the type of surgery you're undergoing, and your overall risk profile.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1002/14651858.cd012584.pub2, Alternate LINK

Title: Continuation Versus Discontinuation Of Antiplatelet Therapy For Bleeding And Ischaemic Events In Adults Undergoing Non-Cardiac Surgery

Subject: Pharmacology (medical)

Journal: Cochrane Database of Systematic Reviews

Publisher: Wiley

Authors: Sharon R Lewis, Michael W Pritchard, Oliver J Schofield-Robinson, Phil Alderson, Andrew F Smith

Published: 2018-07-18

Everything You Need To Know

What are antiplatelet medications and what do they do?

Antiplatelet medications, like aspirin and clopidogrel, are drugs that prevent blood clots by inhibiting platelets from clumping together. They are crucial for individuals with heart conditions, such as those who have experienced a heart attack, stroke, or have had coronary stents placed. These medications help prevent potentially life-threatening thrombotic events. These events include myocardial infarction and acute coronary syndromes which help to stop further damage. The key function is to keep blood flowing freely, preventing clots from forming and causing further health complications.

Why has it been standard practice to stop antiplatelet medications before surgery?

The conventional practice has been to stop antiplatelet medications a few days before surgery to reduce the risk of bleeding during and after the procedure. This approach is based on the understanding that these drugs thin the blood, which can lead to excessive bleeding. However, there is growing evidence challenging this long-held practice, as stopping these medications may not significantly reduce bleeding risks and could increase the risk of dangerous blood clots, especially in patients with cardiac stents. Therefore, this practice is under review due to the potential for increased thrombotic events.

What are the risks associated with stopping antiplatelet therapy before surgery?

The primary risk of stopping antiplatelet therapy before surgery is the increased chance of thrombotic events, such as heart attacks or strokes. For patients with conditions like cardiac stents, the risk is particularly high. These medications are vital for preventing blood clots in these patients, and discontinuing them, even temporarily, can lead to clot formation and potentially life-threatening consequences. This is especially concerning given that these medications are often crucial for preventing myocardial infarction and further strokes.

How should the decision to continue or discontinue antiplatelet therapy be made?

The decision to continue or discontinue antiplatelet therapy before surgery should be highly individualized, considering your specific cardiac history, the type of surgery, and your overall risk profile. Close consultation with your doctor and surgeon is essential. They will evaluate the balance between the risk of bleeding during surgery and the risk of a thrombotic event if the medication is stopped. This personalized approach is a shift from the previous one-size-fits-all advice, reflecting a move toward more tailored medical care.

Why are antiplatelet medications particularly important for individuals with coronary stents?

Coronary stents are small, mesh tubes placed in arteries to keep them open after procedures like angioplasty. Antiplatelet medications are critical after stent placement to prevent blood clots from forming within the stent. If a clot forms in the stent (stent thrombosis), it can lead to a heart attack. Therefore, continuing antiplatelet therapy, or carefully managing its discontinuation, is vital in these cases to minimize the risk of thrombotic events. This helps ensure the stent functions correctly and the patient's blood flow remains unobstructed, especially in the initial months after placement.