A patient who was on aspirin for a long period was selected for an elective surgery. Which of the following should be done next in this patient?
Aspirin inhibits platelet cyclooxygenase leading to irreversible platelet dysfunction. Since it takes 7-10 days to renew the circulating platelet pool, aspirin should be stopped 7-10 days before any surgical procedures. Non steroidal COX1 agents cause reversible inhibition of platelet cyclooxygenase so should be stopped 1-2 days before surgery depending on the half life of the drug. Clopidogrel cause irreversible inhibition of platelet aggregation and should be stopped 7 days before surgery. Antihypeensives, anticonvulsants and antipsychotic medications should be continued through the morning of the surgery. Raloxifene was found to be associated with increased risk of thromboembolic events and should be stopped at least one week before surgery. Ref: Clinical Medicine a Practical Manual for Stud. &pract. by Agarwal By Jaypee Brothers page 90
Infusion of platelet concentrate
Infusion of fresh frozen plasma
Stop Aspirin for 7 days
Go ahead with surgery maintaining adequate hemostasis