RecommendationAssess the risks and benefits of stopping pre-existing established antiplatelet therapy 1 week before surgery. Consider involving the multidisciplinary team in the assessment.
Trade off between clinical benefit and harmsThe benefit of reducing the risk of venous thromboembolism and long term events occurring as a result of thromboembolism were considered against the risk of major bleeding. The group of patients who are receiving antiplatelet or anticoagulation therapy before surgery are at an increased risk of bleeding.
Economic considerationsNo cost effectiveness model was completed to identify the cost effectiveness of stopping these treatments before surgery. The guideline development group felt that the benefits in terms of reducing the risk of bleeding after surgery may, in some patients, outweigh the benefits of maintaining therapy, and therefore felt that it should be considered for all relevant patients.
Other considerationsThis recommendation is based on the recommendation from the previous surgical guideline. This recommendation needs to be carefully considered in the context of the individual patient and should take into consideration all of their existing or potential comorbidities that may occur from stopping treatment. In order to balance these factors, advice from different disciplines may be needed.
The BNF should be consulted for appropriate timing for stopping and restarting antiplatelet therapies around surgery. Current advice suggests that antiplatelets should be stopped 1 week before surgery.

From: 5, Risk, risk reduction and harm

Cover of Venous Thromboembolism
Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital.
NICE Clinical Guidelines, No. 92.
National Clinical Guideline Centre – Acute and Chronic Conditions (UK).
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