Drugs before surgery

Question 1

What drugs should you stop with no alternative given before surgery?

Answer 1

COCP stop 4-6 weeks before
Most cardiac medication should be given over the perioperative period, exceptions include anticoagulants (bleeding risk- doacs 48 hours usually, warfarin 5 days ), aspirin was traditionally held but this beginning to be challenged, ACE inhibitors are held due to risk of renal failure and hypotension

Question 2

Diabetic medication before surgery?

Answer 2

if on insulin can usually adjust regime slightly to take into account fasting

oral drugs:
stop SGLT2i on day of surgery
GLP and DPP can take as normal
sulphonylureas and metformin are generally still taken but may have one dose omitted depending when surgery is and how much they take

Question 3

If someone on warfarin has high thrombotic risk what can they be bridged with in the days running up to surgery?

Answer 3

LMWH e.g. dalteparin - this is shorter acting

Question 4

How many days prior to surgery should you stop warfarin?

Answer 4

5 days

Question 5

What INR should someone be who has stopped warfarin for surgery?

Answer 5

< 1.5