Managing medications before surgery is a crucial step for patient safety and successful outcomes. Adjusting medication regimens is a standard part of pre-operative preparation, aiming to minimize potential risks during and after a procedure. This careful management helps ensure the body is in an optimal state for the surgical process.
General Principles of Pre-Surgical Medication Management
Adjusting or temporarily stopping certain medications before surgery addresses potential interactions and risks. Some medications can increase the likelihood of excessive bleeding, interfering with the body’s natural clotting mechanisms. Other medications can interact with anesthetic agents, potentially affecting heart rhythm, blood pressure, or respiratory function. Careful management of blood sugar levels is also important for individuals with diabetes, as both excessively high or low levels can complicate surgery and recovery.
Key Drug Categories to Discontinue
Several medication categories are commonly recommended for discontinuation approximately seven days before surgery due to their potential to interfere with surgical safety. The exact timing can vary based on the specific drug, the patient’s health, and the type of surgery.
Anticoagulants
Anticoagulants, often called blood thinners, are a primary concern because they reduce the blood’s ability to clot. Stopping these, such as warfarin (Coumadin) or direct oral anticoagulants like apixaban (Eliquis), rivaroxaban (Xarelto), or dabigatran (Pradaxa), is often necessary to reduce the risk of significant bleeding during surgery. Stoppage times vary; warfarin may be stopped around five days prior, while direct oral anticoagulants might be held for three to seven days depending on the procedure and patient’s kidney function.
Antiplatelet medications
Antiplatelet medications, which prevent platelets from clumping, also increase bleeding risk. Common examples include aspirin, clopidogrel (Plavix), ticagrelor (Brilinta), and prasugrel (Effient). Aspirin is often stopped seven to ten days before surgery, though low-dose aspirin may sometimes be continued in specific cases after discussion with the medical team. Clopidogrel is typically stopped seven days before surgery, and ticagrelor generally three to five days before.
Diabetes medications
For individuals managing diabetes, certain oral medications require adjustment. SGLT2 inhibitors, for instance, are usually held at least three days before surgery to mitigate the risk of diabetic ketoacidosis. Medications like semaglutide (Rybelsus) might need to be stopped seven days prior due to their prolonged presence in the body. Metformin is often held 24 hours before surgery to reduce the theoretical risk of lactic acidosis.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen, naproxen, and celecoxib are typically discontinued five to seven days before surgery. NSAIDs impair platelet function, which is critical for blood clotting, thereby increasing bleeding risk. The exact stoppage time can vary based on the specific NSAID and its half-life, with some short-acting NSAIDs requiring only a 1-2 day hold, while others like piroxicam may need 10 days.
Herbal supplements and over-the-counter remedies
Many herbal supplements and over-the-counter remedies can affect bleeding or interact with anesthesia. Products such as ginkgo biloba, garlic, ginseng, fish oil, and high-dose vitamin E have blood-thinning effects and are generally advised to be stopped seven days to two weeks before surgery. St. John’s Wort can interfere with anesthetic medications, and other supplements like Ephedra can affect heart rate and blood pressure.
Weight loss medications
Weight loss medications, including stimulants like phentermine, are often discontinued seven days before surgery because they can influence heart rate and blood pressure, which could complicate anesthesia management. Some GLP-1 receptor agonists (e.g., dulaglutide, semaglutide) may also be stopped seven days prior due to their potential impact on gastric emptying, which can affect the safe administration of anesthesia.
Medications Often Continued Before Surgery
While many medications need to be stopped or adjusted, several categories are generally safe or necessary to continue up to the time of surgery. Maintaining stable chronic conditions is often important for surgical success.
Blood pressure and cardiac medications
Medications for blood pressure management, such as beta-blockers and calcium channel blockers, are frequently continued to ensure stable cardiovascular function. Cardiac medications, including statins and those for heart rhythm regulation, are typically maintained. However, ACE inhibitors and ARBs might be held 12-24 hours before surgery to prevent significant drops in blood pressure during anesthesia.
Other continued medications
Medications for seizure disorders are usually continued to prevent seizures. Thyroid hormone replacements are typically continued to maintain metabolic stability. Patients using asthma inhalers are generally advised to continue their regular regimen for optimal respiratory function.
Standard pain relievers like acetaminophen do not affect blood clotting and are usually safe to take before surgery. Most antidepressant and anti-anxiety medications are also continued to avoid withdrawal symptoms, though specific types like MAO inhibitors require careful consideration.
The Importance of Consulting Your Healthcare Provider
This information serves as general guidance, but it is not a substitute for personalized medical advice from your healthcare team. Your medical history, current health conditions, and the specific surgical procedure determine the tailored medication plan.
Provide a complete and accurate list of all medications, including prescription drugs, over-the-counter remedies, vitamins, and herbal supplements, to your surgeon, anesthesiologist, and primary care doctor. This comprehensive disclosure allows the medical team to create an individualized plan that balances the risks of continuing a medication against the risks of stopping it. The exact timing for stopping or adjusting any medication is precisely determined by your medical team and must be followed carefully. Never stop or change any prescribed medication without explicit instructions from a healthcare professional, as doing so could lead to adverse health outcomes.