Management of Antiplatelet Therapy Before Surgery

Preoperative Discontinuation Timeline

• The American Heart Association recommends discontinuing clopidogrel 5 days before elective non-cardiac surgery to allow adequate platelet function recovery 1, 2, 3
• For patients undergoing CABG, stop clopidogrel at least 5 days preoperatively, as recommended by the American College of Cardiology 1, 2
• Ticagrelor requires only 3-5 days discontinuation, while prasugrel requires 7 days, according to the American College of Cardiology 2, 3

Special Population: Patients with Coronary Stents

• The American Heart Association recommends deferring elective surgery for at least 4-6 weeks after bare-metal stent placement and at least 6 months after drug-eluting stent placement 4, 2, 3
• If surgery cannot be deferred, continue both aspirin and clopidogrel perioperatively, as recommended by the American College of Cardiology 4, 2, 3

Aspirin Management

• The American College of Cardiology recommends continuing aspirin throughout the perioperative period for patients with prior MI, prior stroke, or coronary stents 2
• Continue aspirin for CABG surgery, as recommended by the American College of Cardiology 2

Postoperative Resumption

• The American College of Cardiology recommends resuming clopidogrel within 24 hours after surgery as soon as adequate hemostasis is achieved 2, 3
• Consider a 300 mg loading dose when resuming therapy in patients with drug-eluting stents, as recommended by the American College of Cardiology 2, 3

Multidisciplinary Decision-Making

• The American College of Cardiology recommends mandatory consultation between surgeon, anesthesiologist, and cardiologist for complex cases to weigh thrombotic versus bleeding risks 3