The People's Perspective on Medicine

Should You Stop Taking Aspirin Before a Biopsy?

Aspirin prevents clots but it also increases the chance of bleeding. So deciding whether to stop taking aspirin before a procedure is a tough call.
LLANO TX-AUG 16 2015: Bottle of Bayer Low Dose Aspirin against white background. Recommended by doctors to reduce chance of Heart Attack.

Millions of people take low-dose aspirin (once called “baby aspirin,” though it is not for babies) to protect themselves from blood clots that could lead to a heart attack or stroke. People at higher risk for heart problems or a stroke get the most benefit from aspirin, but they are also most vulnerable to excessive bleeding from the drug (Mora & Manson, JAMA Internal Medicine, Aug. 2016). As a result, they may face a difficult dilemma prior to a surgical procedure: should they stop taking aspirin or not?

Do You Need to Stop Taking Aspirin for a Biopsy?

Q. I need to have a prostate biopsy in a few weeks. I take low-dose aspirin daily on the recommendation of my internist. Will I need to stop the aspirin before the biopsy?

A. You should absolutely check with the urologist at least a week before your biopsy. One study suggested that men need not stop low-dose aspirin prior to biopsy (Vasudeva et al, International Brazilian Journal of Urology, Nov-Dec. 2015).

What Happens If You Stop Taking Aspirin?

Your question is difficult, because research has shown that people who stop taking aspirin for reasons other than for surgery are more likely to suffer a heart attack. Another reader wrote to us about this hazard.

Q. I read your column about a woman who stopped aspirin and had a heart attack. Almost thirty years ago I started taking aspirin.

In December, 2015, I was getting ready to have shoulder replacement surgery. There were a lot of scans and tests to be sure everything looked good before the surgery. They ALL checked out fine. A week before the surgery, I had to stop taking my aspirin, omega-3 fish oil and OTC supplements.

Two days before the surgery, I woke up fuzzy. As it turned out, I’d had a blood clot go to my brain and cause a mild stroke. After three months of heart monitoring and tests, the neurology doctors said it was rare, but they think going off aspirin caused the blood to clot and stop up a small artery.

Serious Consequences for People Who Stop Taking Aspirin:

A. Swedish researchers reported that patients who stop low-dose aspirin appear to be more likely to suffer a heart attack or stroke (Sundstrom et al, Circulation, online, Sept. 25, 2017). They hypothesized that this may be a rebound blood-clotting effect.

This new information poses a dilemma for surgeons. They often advise patients to stop taking aspirin prior to surgery to prevent excessive bleeding. This new information may call for a re-evaluation of the protocol. Unfortunately, we do not have any studies to show us the safest way to stop taking aspirin.

The situation may not be entirely grim. A review of all available well-controlled studies of patients having non-cardiac surgery found that stopping aspirin made little or no difference in serious bleeding (Lewis et al, Cochrane Database of Systematic Reviews, July 18, 2018).  That said, patients undergoing surgical procedures should always check with the surgeon at least a week or two beforehand.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    I also take Eliquis and wonder what choice to make if requIring surgery. Has any research been done in this area?

    I took aspirin for many years and I can’t remember being told to stop aspirin for biopsies. However, 2 years ago I was diagnosed with AFIB. I was taken off aspirin and put on Eliquis. As I get epidural injections every 3 or 4 months for lumbar and sciatic nerve problems, I have to stop Eliquis for 3 days prior. I know for a fact how easy I bleed when I cut myself so I’d rather err on the side of stopping Eliquis than taking a chance of serious bleeding due to an epidural injection.

    I intended to go off aspirin prior to my last colonoscopy, but I simply forgot. I take full-dose aspirin for joint and muscle pain to aid sleep. A polyp was removed during the procedure and, after returning home on a Friday afternoon, I began bleeding and lost a pint and a half of blood before the bleeding stopped 36 hours later. (I collected and measured it after the first 2 blood dumps.) My doctor was unavailable on the weekend. It was very frightening.

    I had heard that bad teeth can cause heart trouble. After I had my heart attack I wanted to get my remaining teeth pulled. A year later I was allowed to have my remaining (16 or 17 teeth) removed. I was told to stop taking my Clopidogrel and baby aspirin two weeks before removal. I had no problem whatsoever, except that losing all of my teeth was a big shock to my lifestyle and eating habits. Do explore the alternatives to drastic surgery.

    I started taking Eliquis after having A-Fib last year in December. I now am concerned that if I have to have surgery of some kind in the future, that I will be advised to go off of the Eliquis and as a result, may experience a stroke or heart attack. Do you think that the guidelines might also change for people who are taking a blood thinner such as Eliquis?

    The problem is there is no helpful research on this issue. Which is the more threatening: the potential of increased bleeding on a procedure or the potential of a clot-induced heart attack? My inclination is to continue the aspirin.

    I wish my nurse-practitioner had told me about the rebound effect while she was insisting I start taking low-dose aspirin. I don’t think I would have done it, and now I don’t know how to get off it safely.

    I was on low-dose aspirin for awhile and wanted to get off after reading about the danger of microbleeds in the brain, but also feared the rebound possibilities. I got off gradually – by going to every other day for a week, then every third day for a week, and so on, until I was down to one a week and then none. No problems experienced. I am an AFIB patient NOT on prescription blood thinners – just fish oil and other supplements with blood thinning side effects.

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