| Name or class of drug | Clinical considerations | Recommended strategy for surgery with brief NPO state | Recommended strategy for surgery with prolonged NPO state |
| Oral contraceptives | Continuation may increase risk of VTE. Discontinuation can result in unwanted pregnancies. | - For patients undergoing surgery with a low to moderate risk of VTE, continue without interruption (with appropriate perioperative VTE prophylaxis).
- For patients undergoing surgery with a high risk of VTE, stop 4 weeks before surgery. For women using them for contraceptive purposes, instruct on alternate forms of contraception and obtain serum pregnancy test immediately before surgery.
| - See recommendations for surgery with brief NPO state.
- Resume when tolerating oral medications.
|
| Postmenopausal hormone therapy | Continuation may increase risk of VTE. | - For patients undergoing surgery with a low to moderate risk of VTE, continue without interruption (with appropriate perioperative VTE prophylaxis).
- For patients undergoing surgery with a high risk of VTE, stop at least 2 weeks prior to surgery and resume once elevated risk of VTE has resolved.
| - See recommendations for surgery with brief NPO state.
- Resume when tolerating oral medications.
|
| Selective estrogen receptor modulators (SERMs) | Continuation may increase risk of VTE. | - For patients undergoing surgery with a low to moderate risk of VTE, continue without interruption (with appropriate perioperative VTE prophylaxis).
- For patients undergoing surgery with a high risk of VTE, our recommendations for timing of discontinuation depend upon the specific SERM and the indication for its use:
- For raloxifene (taken for breast cancer prevention or osteoporosis treatment/prevention), discontinue 3 days prior to surgery and resume once elevated risk of VTE has resolved.
- For tamoxifen (taken for breast cancer prevention), discontinue 2 weeks prior to surgery and resume once elevated risk of VTE has resolved.
- For tamoxifen (taken for breast cancer treatment), we typically recommend continuing while providing appropriate VTE prophylaxis. However, consultation with oncology is advised.
| - See recommendations for brief NPO state.
- Resume when tolerating oral medications.
|
