What is the first action if a patient failed to discontinue aspirin before surgery?

• A. Notify the surgeon immediately
• B. Proceed with surgery while monitoring bleeding
• C. Administer reversal agents
• D. Postpone surgery for a week

Answer: (A)

When a patient has not discontinued aspirin before surgery, the priority is to inform the surgeon right away. Aspirin irreversibly inhibits platelet function, so the risk of intraoperative and postoperative bleeding remains until new platelets are produced, typically about 7 to 10 days. The surgeon needs to assess urgency, balance bleeding risk, and decide whether to delay the procedure, modify the anesthesia plan, or implement specific bleeding precautions. There isn’t a quick reversal for aspirin, and proceeding with surgery or attempting improvised reversal can significantly raise bleeding risk. The decision to postpone should be made in collaboration with the surgeon, based on urgency and overall risk.