perioperative antiplatelet therapy

Management

aspirin:

• aspirin 100 mg QD may be continued before & after surgery for patients with high risk of thrombosis, i.e. recent coronary stent or myocardial infarction
• continue for procedures of low bleeding risk, i.e.minor dental procedures, dermatologic procedures, cataract surgery, colonoscopy
  • aspirin not associated risk of bleeding in dermatologic procedures
• if aspirin is held, stop 7-10 days prior to surgery
• perioperative low-dose aspirin associated with lower risk for death or nonfatal myocardial infarction vs placebo (6% vs 11%) in patients with prior PCI*

P2Y12 inhibitors:

• clopidogrel
  • stop clopidogrel 5 days prior to surgery
  • clopidogrel should be continued perioperatively for
    • drug-eluting stent within 3 months
    • bare metal stent within 30 days
    • myocardial infarction or coronary revascularization within 4-6 weeks
  • if possible, surgery should be delayed until clopidogrel may be stopped
• stop ticagrelor 5-7 days prior to surgery
• stop prasugrel 7 days prior to surgery
• for minor procedures (i.e.minor dental procedures, dermatologic procedures, cataract surgery, colonoscopy), patients receiving single antiplatelet agents should continue them perioperatively
  • patients receiving dual antiplatelet agent theraoy should continue aspirin & interrupt their P2Y12 inhibitor

* witholding low-dose aspirin & clopidogrel may be reasonable if bleeding risk is extreme or consequences catastrophic, as with neurosurgery

NSAIDs:

• generally NSAID stopped 7 days prior to surgery
• stop at least 5 half-lives before surgery
  • 24 hours for ibuprofen
  • days for naproxen

Restart antiplatelet agent about 24 hours after surgery

More general terms

• perioperative management
• anticoagulation

Additional terms

• perioperative anticoagulation