Version June 2024
| Name or class of drug | Clinical considerations | Recommended strategy for surgery with brief NPO state | Recommended strategy for surgery with prolonged NPO state |
| Aspirin | Continuation may cause perioperative hemorrhage. Discontinuation may increase the risk of vascular complications. Discussion with cardiologist appropriate for patients with cardiovascular indications. | Discontinue aspirin approximately seven days prior to noncardiovascular surgery. | Resume with oral intake. |
| P2Y12 receptor blockers (clopidogrel, prasugrel, ticlopidine, ticagrelor) | When used after cardiac stenting procedure, if discontinued can cause cardiac ischemia perioperatively. If continued can result in bleeding complications. Should discuss management with cardiologist. | Ideally, elective procedures should be delayed until the mandatory period of platelet inhibition with these agents is completed. When used for long-term stroke prophylaxis, should be discontinued 7 to 10 days. If discontinuing, stop clopidogrel and ticagrelor at least five days, prasugrel seven days, and ticlopidine 10 days before surgery. When restarting clopidogrel, consider using a loading dose. | Resume with oral intake. |
| Pentoxifylline | If being prescribed for alcoholic hepatitis, consult with prescribing hepatologist. | Take last dose the morning of surgery. However, there is generally no need to cancel/postpone surgery even if medication is continued due to low bleeding risk. | Resume with oral intake. |
| Warfarin | Refer to UpToDate topic on perioperative management of patients receiving anticoagulants. | ||
| Dabigatran, rivaroxaban, apixaban, edoxaban | Refer to UpToDate topic on perioperative management of patients receiving anticoagulants. | ||
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