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Anaesthesia · Local and regional anaesthesia: aspirin and neuraxial block
Sample itemA 70-year-old taking aspirin 75 mg daily alone for ischaemic heart disease is booked for transurethral resection under spinal anaesthesia. Platelet count and clotting tests are normal. What is the appropriate approach?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Proceed with the spinal as planned
Aspirin on its own does not significantly raise the risk of spinal haematoma, so a neuraxial block can go ahead when there is no other coagulation problem. Risk rises when aspirin is combined with other anticoagulants or antiplatelet drugs. Stopping it needlessly raises cardiac risk.
Option by option
A. Choose general anaesthesia only
General anaesthesia is not required, and it would remove the benefits of regional technique.
B. Proceed with the spinal as planned (correct)
Correct. Aspirin alone does not meaningfully add to haematoma risk after a neuraxial block.
C. Transfuse platelets before the block
Platelet transfusion has its own risks and is not indicated with a normal count.
D. Postpone surgery for seven days off aspirin
Stopping aspirin is unnecessary and exposes the patient to coronary events.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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