Drugs to stop before surgery

Question 1

when should clopidogrel be stopped?

Answer 1

7 days before surgery

Question 2

when should warfarin be stopped?

Answer 2

5 days
put pts on LMWH until the night before

Question 3

when should ACEi be stopped?

Answer 3

the day before surgery

Question 4

when should insulin be stopped?

Answer 4

Insulin should be held on the day of surgery (only the short-acting preparations)

Question 5

when should sulfonylureas be stopped?

Answer 5

sulfonylureas should be held on the day of surgery (due to the risk of hypoglycaemia)

if taking 2 doses, hold one prior to surgery and take afternoon dose

Question 6

when should metformin be stopped?

Answer 6

metformin can be given as normal for short procedures up to BD. For longer procedures when the patient is not eating and drinking for several days or if there is a risk of developing AKI, metformin should be held and variable-rate insulin prescribed.

Question 7

when should SGLT2i be stopped?

Answer 7

omitted on the day of surgery and not restarted until the patient is stable; their use during periods of dehydration and acute illness is associated with an increased risk of developing diabetic ketoacidosis

Question 8

when can short acting insulin be restarted?

Answer 8

once the patient is eating and drinking as usual again.

Question 9

when will diabetic patients have their surgery?

Answer 9

first on operative lists as they may have been admitted the night previously so that they can be started on a variable rate insulin infusion on the morning of the procedure

Question 10

when should the COCP be stopped?

Answer 10

4-6 weeks before surgery, and re-started at least 2 weeks after surgery (when the patient is mobile). This reduces the risk of DVT.