A patient on aspirin 75 mg daily for coronary stent placed 3 months ago is scheduled for elective laparoscopic cholecystectomy. The MOST appropriate perioperative antiplatelet management is:

• A Stop aspirin 7 days before surgery to reduce bleeding; restart on the first postoperative day
• B Bridge with intravenous tirofiban (GPIIb/IIIa inhibitor) during the perioperative period
• C Stop aspirin 10 days before surgery and restart only when full oral intake is resumed
• D Continue aspirin perioperatively; do not discontinue for elective surgery with low-to-moderate bleeding risk ✓

Explanation

For patients with drug-eluting coronary stents within the first 6 months, aspirin monotherapy (if dual antiplatelet therapy has been completed) should be continued throughout the perioperative period. Premature cessation risks stent thrombosis, a potentially fatal complication. Laparoscopic cholecystectomy carries low-to-moderate bleeding risk, and continuing aspirin increases bleeding by approximately 20% but does not increase transfusion rates significantly. ACC/AHA guidelines recommend continuing aspirin where possible in patients with recent coronary stenting; the decision to stop should involve the cardiologist.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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