Antiplatelet drugs, anticoagulants and elective surgery

There is an increased risk of bleeding when patients taking anticoagulant or antiplatelet drugs require surgery. This risk must be balanced against the risk of harm if treatment is stopped. For many minor procedures aspirin or warfarin can be continued. Patients having non-cardiac surgery may be able to continue aspirin, but clopidogrel should be stopped unless there is a high risk of thrombosis. Patients taking warfarin may require bridging anticoagulation around the time of major surgery. This involves replacing the warfarin with unfractionated or low molecular weight heparin. Consultation with a cardiologist is particularly recommended if a patient with a coronary stent requires surgery.