Great question! 

There is not a simple answer. The patient comorbidities dictates the appropriate answer.

1. Healthy patient with no cormorbid disease - 7 days.

2. Patients with coronary stents - 0 days.

Each patient's risk/benefit has to be assessed. Minimal bleeding with resulting LAD thrombosis is not the desired outcome. 

Technique for TURP?

Loop resection or laser vaporization?

Patient' starting hgb? Availability of transfusion?

Involve patient in risk discussion.

Regards,

Christopher

Guidelines in my hospital are similar yo those exposed by Dr. Smith.

If  AAS is used as primary profilaxis, 5 yo 7 days.

In secondary profilaxis or parients with coronary stents: 0 days.

I was wondering if you measured incidence of postoperative cerebrovascular events? The studies showed that the discontinuation of aspirin to the occurrence of acute cardiovascular events was 8 ± 3 for acute coronary syndrome and 14 ± 11 days for acute cerebral event. In urology department we abolish Aspirin for 3 days for both group of patients. For cholecystectomy and hernia we do not stop. We are doing a lot of neuroaxial anesthesia but we do not use this an.techiques if the ptc did not discontinue Aspirin, even that European guidelines says different.

I must say that it is all just a risk-benefit analysis. There are several anecdotal incidences of cerebral and cardiac thrombosis following discontinuation of antiplatelet therapy preoperatively. Bleeding is quite a bit easier to treat than the aforementioned thrombosis. This is probably why the vast majority of TURPs that I am involved in are performed under general anesthesia. Statistics are great for scientific inquiry but if your patient is the one percent mortality statistic then 100% of their family is affected adversely. 

Cheers,

Christopher

I think as per AHA 2014, if the patient has a coronary stent in situ, and you have to undergo a non-cardiac surgery, no need to stop Aspirin

при полостных операциях отменяем аспирин за 5 дней. Предоперационная профилактика низномолекулярными гепаринами

"Although aspirin increased the incidence of bleeding by 50%, it did not increase the severity or perioperative morbidity/mortality, except in intracranial surgery and, possibly, transurethral prostatectomy".(Burger W, et al.  meta-analysis. J Intern Med 2005; 257: 399–414.)

"found that aspirin (150 mg) continued in the perioperative

did not affect intraoperative blood loss but postoperatively

the blood loss in the aspirin group (median 284; quartiles 196–660

mL) was significantly higher than in the placebo group (median 144;

quartiles 75–379 mL, P = 0.011)".(Nielsen JD et al. The effect of low-dose acetylsalicylicacid on bleeding after transurethral prostatectomy—a prospective,randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol.2000;34:194–198.

"Surgical procedures that involve particular anatomic locales (middle

ear, posterior chamber of the eye, intracranial, intramedullary

spine, and possibly TURP) confer the highest risk of complicating

hemorrhage while on aspirin therapy".((Ann Surg 2012;255:811–819)