HT on medication: aspirin

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I am looking for advice on doing a HT while on aspirin. Sharing any case on this would help me big time.

Additional context -
HT surgeons generally recommend to stop aspirin 10 days prior to HT since aspirin is a blood thinner.
I am on a mandatory aspirin prescription (75 mg daily), owing to a coronary angioplasty about 2.5 years ago. As a rule of thumb, people with such a condition are recommended to not stop the medication, especially for elective surgeries. There are of course situations where the "reward" of stopping medication outweighs the results (a major surgery / accident etc). A cardiologist would evaluate this on a case by case basis. HT however, does not warrant stopping medication.

My cardiologist suggested me to wait to 2 years post angio. After which I can go ahead with HT, but should not stop medication. I am concerned if this extra bleeding can botch my HT.

[Britanium]

@DrTBarghouthi could help with this question.

[DrTBarghouthi]

Thanks for the mention @JohnAC71

This is a rather broad topic. In general, for stable conditions and low risk cases, Aspirin cessation is advised 10 days before following clearance from your cardiologist. In more unstable cases or higher risk cases, surgery can be done but the number of grafts is kept lower and the use of tumescent anesthesia is increased to control bleeding as much as possible. There is however a nice article looking at successful transplants on patients without stopping any anticoagulant therapy. 
The guidelines also suggest that in cases that can not be stopped, taking half the dose few days before might be a good solution from a cardiac and surgical point of view. Maybe run that possibility with your cardiologist?

 

Here is the title of that paper I mentioned :

Guidelines for perioperative antithrombotic therapy in hair restoration surgery: management of patients with coronary heart disease, mechanical heart valve, and atrial fibrillation

Author: Kuniyoshi Yagyu

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Thank you, @DrTBarghouthi and @JohnAC71. The paper was very informative.

About my case: I underwent coronary angioplasty in LAD artery in March 2018, ie ~2.5 years ago. I am currently on this medication - 

1. Atorvastatin: 10 mg daily
2. Clopidogrel: 75 mg daily
3. Aspirin IP: 75 mg daily

For my case, I found the following section in the paper especially useful - 

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Drug eluting stents and antithrombosis. 
Two types of antiplatelet drugs should be continued within 12 months after stent implantation using the drug eluting stent. Usually, a combination of aspirin (75-300mg/day) and clopidogrel (75mg/day) is prescribed for 1 year. Antiplatelet drugs should not be stopped, and hair transplantation should be postponed until 1 year after the stenting in these patients.

In patients more than 1 year after the stent implantation using a drug eluting stent, two types of antiplatelet drugs are usually continued. In these patients, hair transplant session is possible. You can stop clopidogrel for 5 days as long as you continue aspirin before surgery. If you want to stop both drugs before surgery, you can stop them for only 3 days, but not longer. After the hair transplantation, both drugs should be restarted.

In patients more than 2 years after stent implantation using a drug eluting stent, one antiplatelet drug (aspirin or clopidogrel) is continued in the long-term. You can stop aspirin for 3-5 days, or low-dose aspirin can be continued before surgery. Low-dose aspirin does not cause hemorrhagic tendency, and it can be continued before surgery. Safe hair transplantation is possible in these patients. Antiplatelet drugs should be restarted on the next day after the hair transplantation.

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Also summarised nicely in the attached image.

My case is somewhere bw the last two branches. More close to the last branch (DES -> > 2 years). 
I will get a consult from my cardiologist and see if he recommends doing HT under the same medication, or under reduced dosage for 3-5 days. Will update soon 🙂

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Update:

My cardiologist has recommended to stop Clopidogrel for 7 days (5 days before surgery and 2 days post-op). So the revised medication is - 

1. Atorvastatin: 10 mg daily
2. Aspirin: 75 mg daily

 

[DrTBarghouthi]

Yes It is a great paper and I use it as my preferred protocol. In some cases cardiologists allow us to half the dose of Aspirin too which helps but having said that we sometimes have to operate without stopping the Aspirin.