Part III Intercollegiate exam / Medications to discontinue before surgery?

Warfarin: see “Surgery in patients on anticoagulants”

Aspirin (antiplatelet): some believe in stopping aspirin 48 hrs before surgery (1), however in the past few years due to increased risk of ischaemic events it discontinuation has been challenged (2). Most experts advise continuation of aspirin.

Clopidogrel (antiplatelet): Clopidogrel should preferably be discontinued 5 days prior to surgery (2). However if the risks of stopping treatment are high (eg, recent coronary angioplasty or stent with in 3 months), clopidogrel cann’t be stopped. Either postpone surgery (re-plan after discussing with cardiologist) or use aprotinin to normalise risk of bleeding at surgery (2,3).

Can you transfusion of platelets reduce the risk of bleeding?
No, anti-platelet (especially clopidogrel) act by inhibiting platelet function ( even if they are transfused) rather than reducing their counts.

Drugs that may interfere with anaesthetic agents:

Monoamine oxidase inhibitors
Lithium
Tricyclic antidepressants
Phenothaizines

Oral contraceptives: should be stopped preferably 4 weeks prior to surgery

(HRT need not be stopped)

Further reading:

1) Preoperative preparation for surgery: RCS course manual – clinical surgery in general

2) Antiplatelet agents and perioperative bleeding: Can J Anaest 2006 (free dowload)

3) Perioperative use of anti-platelet drugs; Best pract and res Clin. Anaesth. 2007

Others in this Category

	Massive transfusion
	Disseminated intravascular coagulation (DIC)
	Pathophysiological of pnemoperitoneum in Laparoscopic surgery
	Surgery in patients on anticoagulants
	Management of Atrial Fibrillation
	How would you investigate a patient with Iron deficiency anaemia?