What is the preoperative evaluation and management of aspirin and NSAIDS?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

Intraoperative or postoperative bleeding is one of the most undesirable surgical complications. Several commonly prescribed medications can interfere with the normal coagulation process. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit platelet function, thereby serving as a major source of perioperative bleeding in surgery. Aspirin irreversibly inhibits cyclooxygenase, the enzyme responsible for ultimately catalyzing the formation of prostaglandins. Aspirin irreversibly inhibits cyclooxygenase, and its effect lasts the entire duration of the platelets' lifespan (7-11 d). Aspirin can be restarted 1 day after surgery if medically necessary. Otherwise, restarting the drug 5-7 days after surgery is probably best.

During surgery, compression stockings are recommended, and altering the amount of calf compression is ideal.

Most dermatologic procedures are superficial, and although the patients may have increased bleeding with the use of aspirin, warfarin (Coumadin), and enoxaparin (Lovenox), it is advised that these medications be continued if the patient has had atrial fibrillation, previous stroke, or other cardiac conditions that mandate these medications. [11] Understandably, wound healing difficulties will occur with anticoagulation; nonetheless, this does not preclude the need for maintenance of the above medications.

NSAIDs reversibly inhibit cyclooxygenase, causing a similar effect that only lasts as long as the NSAID is in the system. It takes approximately 4.5 half-lives for any drug to reach negligible levels from its effective dose. Similar to aspirin, NSAIDs can be restarted 1 day after surgery if absolutely necessary, but using nonaspirin, non-NSAID pain relievers postoperatively is most prudent. Discontinuation of aspirin 2 weeks prior to surgery and of NSAIDs at least 5 half-lives of that particular NSAID dose prior to surgery is recommended.


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