14. We recommend against initiation of ASA for the prevention of perioperative cardiac events (Strong Recommendation; High-Quality Evidence).
15. We recommend against the continuation of ASA to prevent perioperative cardiac events, except in patients with a recent coronary artery stent and patients who undergo carotid endarterectomy (Strong Recommendation;High-Quality Evidence).

The timeline to define “recent” coronary stent varies on the basis of the type of stent but usually refers to 6 weeks for bare-metal stent and between 3 and 12 months for drug-eluting stent, depending on the stent generation. Physicians should discontinue ASA at least 3 days before noncardiac surgery to reduce the risk of major bleeding.56 In patients with an indication for chronic ASA, it is important to restart ASA when the risk of bleeding related to surgery has passed (ie, 8-10 days after major noncardiac surgery).55 Perioperative ASA continuation might be reasonable for some surgical interventions to prevent local thrombosis (eg, free flap, acute limb ischemia). When a patient suffers a myocardial injury or thrombotic event after surgery in the absence of bleeding, there might be a net value to restarting ASA sooner after surgery than 8-10 days.