Patients on Aspirin requiring Vasectomy

Aspirin and vasectomy…

Aspirin and vasectomy is a common issue raised by patients. Find below some answers.

(note, this advice is the same for patients on Clopidogrel = Plavix, another similar blood thinning drug often taken i.e. by patients allergic to Aspirin. Just read this article as if Aspirin equalled Clopidogrel)

What does Aspirin do?

Aspirin is a blood thinner that avoids blood clotting by irreversibly inhibiting platelet aggregation in your blood. Platelet half time in your blood is 5 days. Thus, after 10 days still roughly 25% of your platelets cannot aggregate. You can see, how long it takes for the effects of Aspirin to reduce its effect.

Benefits of Aspirin:

Secondary Prevention: By reducing the ability of your blood to clot you can improve circulation in areas that are poorly circulated, for example after heart surgery a stroke or a heart attack. Thus, you take it, because a health event has already occured.

Primary Prevention: However, there are also people that take Aspirin for Primary prevention (no previous problems, but a choice) for example 50-70 year olds according to the recommendation of the US FDA as Aspirin is an effective cancer preventer.

What else can I do to avoid clotting:

Thick blood clots quicker than thin blood, so for example being well hydrated is a good way of avoiding more blood clotting than necessary and I would recommend anyone choosing to stop Aspirin before Minor surgery that they always ensure to be well hydrated while Aspirin is stopped.

Is Vasectomy Minor Surgery?

Yes and No. While the procedure is definitely Minor Surgery the side effects of a bleed are significantly more pronounced because the “skin turgor” of the scrotum is almost nil. This means the skin isn’t pressing on the wound to stop bleeding like for example on the arm or leg. Thus, a scrotum can more easily fill up with blood and takes longer to absorb. Aspirin and vasectomy is definitely a specific issue.

Should I stop Aspirin before surgery? And when should I re-start?

In Major Surgery Aspirin is generally stopped before surgery and replaced with Heparin. In Minor Surgery and vasectomy it depends as there is a balance to be struck between the bleeding risk and the risk to your safety.

Its probably not good to stop Aspirin if you are taking it for secondary prevention (i.e. due to a previous problem with your heart or brain). If you however take it for Primary Prevention you should strongly consider to stop Aspirin.

If you choose to stop Aspirin it doesnt make sense to stop the day before as it wont work, you have to stop at least 10-14 days prior to the procedure and also not re-start while bleeding risk is increased i.e. a week after the procedure.

How high is my risk of clotting if I choose to stop Aspirin?

It is very important to be statistically savvy. Aspirin reduces the chance of blood clotting, it doesnt mean it stops you clotting. You can still clot while on Aspirin, but there is generally a 30% risk reduction. I.e. if 3 out of 100 patients would have a blood clot without Aspirin there would then be only 2 out of 100 patients having a blood clot once they take Aspirin.

In other words: Most patients stopping Aspirin will not get a blood clot, but run a slightly higher risk, but equally even if you are on Aspirin you still could get a blood clot.

If I have a procedure on Aspirin, will I definitely bleed?

No. Most patients are absolutely fine, but occasionally we have had patients with longer stays and more problems. Statistically, your risk is higher, but that doesn’t mean you will have problems.

Finally, what should I do?

For me as a doctor, it is very important for you as a patient to be well informed. Thats why I have written the above article. Based on this information we can then make a shared decision balancing risks vs benefit of stopping. In the end your decision is final. All I am asking you is that you consider the issues around Aspirin and Vasectomy. if you choose to stop Aspirin to ensure your hydration levels are adequate throughout the time. If you choose to stay on Aspirin I want you to not worry about it as we doing everything in our power to make your experience as good as anyone elses.

Dr Kittel, August 2020

For information about Aspirin in Minor Surgery click here (very similar article, though)