Medication and Surgery

Peri-Operative Medication Management

  • 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

  • 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)