Antiplatelets for Procedures: Aspirin, Clopidogrel, Ticagrelor

This is a conservative overview for clinicians. Cardiology input is important for patients on dual therapy or with recent coronary stents.

Start with the indication

Clarify why the patient takes antiplatelets. Recent PCI with stents, secondary prevention, or stroke prevention each carries different tradeoffs. Involve the prescriber if the risk of thrombosis is high.

When to continue and when to hold

• Aspirin: many low risk procedures continue aspirin. For higher risk bleeding procedures, consider a hold based on local policy.
• Clopidogrel or ticagrelor: more often held for higher risk procedures. Time off drug varies by agent and setting. Coordinate with cardiology if stents are recent.
• Dual therapy: weigh bleeding risk and thrombotic risk. A shorter hold or staged procedure may be safer. Specialist input helps.

Restart

Restart after hemostasis is secure. If thrombotic risk is high, plan the earliest safe restart and confirm with the prescriber. Document the plan clearly.

Practical examples

• Dermatologic excision on aspirin for secondary prevention. Continue if local policy allows. Use careful hemostasis.
• Planned polypectomy on clopidogrel. Treat as higher risk. Hold per local policy. Restart after hemostasis is secure.
• Dual therapy with recent stents. Coordinate with cardiology. Consider delaying elective work if possible.

For anticoagulant timing rather than antiplatelets, use the AnticoagPlanner calculator and review the DOAC and warfarin guides.

Sources

• Institutional perioperative antiplatelet practices and cardiology consensus sources.
• Local policy and specialty guidelines should guide final decisions.