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Medication and Surgery
Peri-Operative Medication Management
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Below are general recommendations to guide you in managing your medications around the time of surgery. These are consensus guidelines but not agreed upon by all physicians. Please confirm with the physician who prescribed you any particular medication to confirm agreement with the date ranges below.
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Medication | Stop Before Surgery (Days) | Start After Surgery (Days) | Comment |
|---|---|---|---|
Abciximab (ReoPro) | 12-24 hours | Varies | |
Apixaban (Eliquis) | 3 days | 48 hours | |
Apremilast (Otezla) | Not Necessary | Immediately | In high risk patients, can hold 3d before surgery |
Argatroban | 4 hours | 1 hour | Defer surgery until off medication unless urgent |
Aspirin | 5 days | 1 day | Does not need to be held for "minor" procedures |
Aspirin/Dipyrimadole (Aggrenox) | 5 days | 1 day | |
Azathiop | |||
Azathioprine | 1 week | Immediately | |
Bivalirudin (Angiomax) | 4 hours | 1 hour | Defer surgery until off medication unless urgent |
Celecoxib (Celebrex) | 2-3 days | Varies | |
Clopidogrel (Plavix) | 5 days | 1 day | |
Cyclosporine A | 1 week | 3-5 days | If disease is severe, can continue |
Dabigatran (Pradaxa) | 2-3 days | 48 hours | Defer surgery until off medication if possible. Wait 3-5 days if CrCl < 50mL/min |
Diclofenac | 24 hours | Varies | |
Difunisal | 2-3 days | Varies | |
Eptifibatide (Integrilin) | 4 hours | Varies | |
Fondaparinux (Arixtra) | 2-3 days | 6 hours | If CrCl < 50mL/min, hold 3-5 days before surgery |
Heparin | 2-4 hours | 1 hour | aPTT < 1.5x control |
Hydroxychloroquine | Not necessary | Immediately | |
Ibuprofen (Advil, Motrin) | 7 | TBD | |
Ibuprofen (Advil, Motrin) | 24 hours | Varies | Half-life 2-6 hours |
Indomethacin | 24 hours | Varies | |
Ketoprofen | 24 hours | Varies | |
Leflunomide | Not necessary | ||
Low Molecular Weight Heparin (Lovenox) | 12 hours | 6 hours | If high bleeding risk, held for 24 hours prior to surgery |
Meloxicam (Mobic) | 10 days | Varies | Half-life > 20 hrs |
Methotrexate | Not necessary | Immediately | null |
Mofetil | 1 week | 3-5 days | If disease is severe, can continue |
Mycophenolate | 1 week | 3-5 days | If disease is severe, can continue |
Nabumetone | 10 days | Varies | |
Naprosyn (Aleve) | 7 | ||
Naproxen (Naprosyn) | 2-3 days | Varies | Half-life 7-15 hours |
Piroxicam | 10 days | Varies | |
Prasugrel (Effient) | 5 days | 1 day | |
Rivaroxaban (Xarelto) | 2-3 days | 48 hours | If CrCl < 50mL/min, hold 3-5 days |
Sulfasalazine | Not necessary | Immediately | |
Sulindac | 2-3 days | Varies | |
Tacrolimus | 1 week | 3-5 dyas | If disease is severe, can continue |
Tafacitinib | 1 week | 14 days | |
Ticagrelor (Brilinta) | 5 days | Immediately | |
Ticlopidine (Ticlid) | 7 days | 1 day | |
Tirofiban (Aggrastat) | 4 hours | Varies | |
Vitamins, herbs, dietary supplements | 10 | 7 | |
Warfarin (Coumadin) | 5 days | 12-24 hours | Can be held 3d prior to "minor" procedures, |
References
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Gualtierotti R, Parisi M, Ingegnoli F. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview. Adv Ther. 2018;35(4):439–456. doi:10.1007/s12325-018-0686-0 (Pubmed Link)