Perioperative Management of Hydroxychloroquine

Introduction to Hydroxychloroquine Management

The American College of Chest Physicians guidelines for perioperative management of antithrombotic therapy do not list hydroxychloroquine among medications requiring interruption, as it does not increase bleeding risk 2, 4
Hydroxychloroquine does not affect platelet function or coagulation and does not need to be discontinued before surgery, according to the Anaesthesia journal 1

Anticoagulants like warfarin typically need to be stopped 5-6 days before surgery to allow normalization of a blood clotting measure 2
Antiplatelet medications such as clopidogrel and prasugrel should be discontinued 5-7 days before surgery in most cases, as recommended by the Anaesthesia journal 1

Sudden discontinuation of hydroxychloroquine in patients with autoimmune conditions may lead to disease flares, which could complicate postoperative recovery, according to Praxis Medical Insights 5
Maintaining hydroxychloroquine therapy throughout the perioperative period helps prevent flares of underlying autoimmune conditions, as stated in Praxis Medical Insights 5
Hydroxychloroquine does not increase the risk of surgical bleeding or complicate neuraxial anesthesia, as reported in the Anaesthesia and Blood advances journals 1, 6

Anticoagulants: Stop warfarin 5 days before surgery; newer anticoagulants 2-5 days before surgery depending on kidney function and bleeding risk, according to the Blood journal 7
Hydroxychloroquine and other disease-modifying antirheumatic drugs: Continue through the perioperative period, as recommended by Praxis Medical Insights 5

For minor procedures: Continue hydroxychloroquine without interruption, as recommended by the Anaesthesia journal 1
For major surgeries: Continue hydroxychloroquine throughout the perioperative period, according to the Anaesthesia journal and Praxis Medical Insights 1, 5
For emergency surgeries: No need to delay surgery due to hydroxychloroquine use, as stated in the Anaesthesia journal 1