Poison Center, MacKay Memorial Hospital: Perioperative Antithrombotic Management: Recommended Interruption Period

2026年10月12日星期一

Perioperative Antithrombotic Management: Recommended Interruption Period

Paracelsus emphasized that toxicity is defined by dose, clinical toxicology and pharmacology also guide the therapeutic safety window—specifically, balancing total drug exposure against bleeding risks during invasive procedures. The dose makes the poison）[1]

In keeping with this principle, the Poison Prevention and Treatment Center website also provides general recommendations on the appropriate discontinuation intervals for various antithrombotic medications before surgery, serving as a practical reference for clinical use.

Perioperative Antithrombotic Management: Recommended Interruption Period

Important Warning: Patients with recent coronary stent placement, acute coronary syndrome (ACS), mechanical heart valves, or recent venous thromboembolism (VTE) must not stop these medications on their own. Consultation with a cardiologist or specialist is required prior to any dose adjustment.

Risk Stratification Criteria [2]

Minor Surgery (Low Bleeding Risk): E.g., minor skin excision, simple dental extractions, cataract surgery, and other low-risk procedures.
Major Surgery (Moderate to High Bleeding Risk): E.g., major abdominal surgery, joint replacement, spine surgery, and other moderate-to-high risk procedures.
Extremely High-Consequence Bleeding Risk: E.g., neuraxial anesthesia, spinal, or intracranial surgery. These procedures require stricter interruption protocols beyond standard high-risk guidelines.

Perioperative Drug Interruption Summary Table

Drug Class & Medication	Minor Surgery (Low Bleeding Risk)	Major Surgery (High Bleeding Risk)
DOACs / NOACs (Apixaban / Eliquis, Rivaroxaban / Xarelto, Edoxaban / Lixiana) Xa inhibitor	Typically hold for 1 day (can be continued for certain minimal-risk procedures)	Typically hold for 2 days [3]
Dabigatran (Pradaxa) (Direct Thrombin Inhibitor)	Typically hold for 1 day (extend duration if renal function is impaired) [4]	Typically hold for 2–4 days (adjust according to renal function/CrCl) [4]
Aspirin (COX-1 inhibitor; reduces platelet aggregation)	Usually continued	Decision based on indications and bleeding risk; if discontinuation is indicated, hold for 4–7 days [5]
Ticagrelor (Brilinta) (P2Y₁₂ receptor antagonist)	May consider continuing for low bleeding risk procedures	Typically hold for 3–5 days [6].
Clopidogrel (Plavix) (P2Y₁₂ receptor antagonist)	May consider continuing for low bleeding risk procedures	Typically hold for 5–7 days [6].
Prasugrel (Effient) (P2Y₁₂ receptor antagonist)	May consider continuing for low bleeding risk procedures	Typically hold for at least 7 days [6]
Enoxaparin (LMWH) (Anti-Xa to Anti-IIa ratio ranges between 2:1 and 4:1)	• Prophylactic dose: Hold for at least 12 hours • Therapeutic dose: Hold for at least 24 hours	• Prophylactic dose: Hold for at least 12 hours [5] • Therapeutic dose: Hold for at least 24 hours [5]
Warfarin (Vitamin K Antagonist)	Can be continued for many minor dental, dermatologic, and cataract procedures	Typically hold for 5 days; verify preoperative INR before procedure [5].