Perioperative Management of Naproxen with Antiplatelet Effects

Mechanism and Bleeding Risk

Naproxen has antiplatelet effects that can increase the risk of perioperative bleeding due to its inhibition of platelet aggregation, as considered by the American Academy of Family Physicians 1, 2
The antiplatelet effects of NSAIDs, such as naproxen, are an important consideration in the perioperative setting and require appropriate discontinuation before surgical procedures, according to the American Academy of Family Physicians 1

For patients at high risk of cardiovascular events who are taking naproxen for secondary prevention, the decision to discontinue should carefully weigh thrombotic versus bleeding risks, as recommended by the American Academy of Family Physicians 1
For minor procedures with minimal bleeding risk, such as dental or dermatologic procedures, continuing naproxen may be considered if the cardiovascular risk is significant, as suggested by the American Urological Association and the American College of Chest Physicians 3, 4

The bleeding risk is further increased when naproxen is combined with anticoagulants or other antiplatelet medications, as noted by the American Academy of Family Physicians 1, 2
Patients may not report over-the-counter use of naproxen unless specifically asked, so thorough medication reconciliation is essential, as emphasized by the American Academy of Family Physicians 2