Blood thinner and Surgery or Dental procedures

This article is designed to expand of the advice we often hand out for our patients with stents, atrial fibrillation or heart disease who require non cardiac surgery or dental procedures. It is designed to assist decision making on which (if any) medication should be altered prior to the elective surgery.  In many cases this can be used without reference to Cardiologist but where doubt exists, advice should be sought and the relevant protocol followed. 

Section 1 for patients Not taking Anticoagulants 

Protocol A Low risk Dual Antiplatelet therapy

Protocol A is generally recommended for those patients taking 'Dual antiplatelet therapy'- usually Aspirin 75 mg combined with either Clopidogrel or Prasugrel following a 'Coronary Syndrome', heart attack or Stent- usually for 12 months, after which in most cases one of the antiplately drugs is discontinued. In some cases both are continued long term providing there are no side effects.

Providing the Coronary anatomy, type and location of stents is considered low risk by the Cardiologist, there will be agreement to stop Clopidogrel or Prasugrel 7 days prior to planned surgery to reduce risk of bleeding complications but to continue Aspirin throughout.  Both drugs should be resumed a day or so post operatively.

Protocol B High risk Dual Antiplatelet therapy

Protocol B is generally recommended for those patients taking 'Dual antiplatelet therapy'- usually Aspirin 75 mg combined with either Clopidogrel or Prasugrel following a 'Coronary Syndrome', heart attack or Stent- usually for 12 months but in high risk cases for longer.

Where the Coronary anatomy, type and location of stents is considered high risk (of stent thrombosis) by the Cardiologist, there will be concerns about stopping Clopidogrel or Prasugrel 7 days prior to planned surgery to reduce risk of bleeding complications.

In these cases either the surgery should be deferred or if possible undertake while taking dual antiplatelet therapy.

If this is not deemed possible then one antiplatelet drug shoudl be discontinued 7 days prior to Surgery but low molecular weight heparin (DVT Treatment dose) given to cover the high risk period - usually starting 3-4 days prior to surgery and continued for 3 days after- having restarted both antiplatelet drugs on the 1st or 2nd post operative day.

Section 2 for patients taking Anticoagulants 

Anticoagulants drugs include: Warfarin, Sinthrome, Dabigatran, Rivaroxiban, Apixaban.

 

 




Written by

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Edward Leatham is a Consultant Cardiologist in Surrey and a Trustee of Haste and Haste Academy.

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