ORTHOPEDIC PREOPERATIVE GUIDELINES FOR ANTIPLATELET, ANTICOAGULANT AND ANTIFIBRINOLYTIC AGENTS

(These guidelines strictly refer to total joint patients only; see PREOP guidelines for regional anesthesia/other surgical procedures) Effective September 29, 2016
Drug When to Stop Before Procedure
Abciximab 2-5 days
Alteplase 10 days
Apixaban 5 days
Argatroban 8-10 hours
Aspirin (and aspirin combinations)* No need to stop
Cilostazol 2 days
Clopidogrel** 7 days
Dabigatran# (CrCl > 30) 5 days
Dabigatran# (CrCl < 30) 7 days
Diclofenac 7 days
Dipyridamole 2 days
Enoxaparin 24 hours
Eptifibatide 8-24 hours
Etodolac 7 days
Fondaparinux 4 days
Heparin, Unfractionated SQ 5000 units BID or TID Avoid peak effect 20’- 4 hrs
Heparin, Unfractionated Intravenous 6 hours
Ibuprofen 7 days
Indomethacin 7 days
Ketorolac 7 days
Meloxicam 7 days
Nabumetone 7 days
Naproxen 7 days
Oxaprozin 7 days
Piroxicam 7 days
Prasugrel 7-10 days
Reteplase 10 days
Rivaroxaban 5 days
Streptokinase 10 days
Tenecteplase 10 days
Ticagrelor 5-7 days
Tirofiban 8-24 hours
Urokinase 10 days
Warfarin#& 7 days, INR <1.3
Supplements and Vitamins: Stop 7 days before surgery
*See separate medication guidelines for Aspirin instructions for surgery; typically if taken for primary prophylaxis stop 7 days preoperatively; if taken for secondary
prophylaxis continue 81 mg daily, including day of surgery. **Must consider if safe to stop based on ACC/AHA guidelines. #Bridging therapy should be determined with
prescribing physician. &An INR must be done the day before surgery in patients who hold warfarin for < 7days.