Discontinuation and reinstitution of medications during the perioperative period

Pass, Steven E.; Simpson, Robert W.

doi:10.1093/ajhp/61.9.899

Cited by 47 publications

(28 citation statements)

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“…In recent studies, the bleeding and transfusion rate following coronary artery bypass grafting was increased by 50% when combined clopidogrel and aspirin therapy was continued [13,14]. The practice of withholding antiplatelet agents 7 to 10 days before surgery to prevent excessive bleeding is widespread [15,16]. It is also known that many urology patients will be on long-term, low-dose aspirin, which is perhaps self-prescribed or prescribed by their general practitioner, usually as a prophylactic treatment for cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

et al. 2012

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PurposeHistorically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy.Materials and MethodsA total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded.ResultsThe patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test.ConclusionsThere were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy.

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Section: Discussionmentioning

confidence: 99%

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

et al. 2012

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“…For this reason, patients receiving β blockers as outpatients are instructed to continue their medication around the time of surgery (including taking their medication on the morning of operation) and typically do not switch to a different agent in the same class 30 – 32. Furthermore, patients are typically prescribed the same β blockers while in hospital after surgery as they had been originally receiving 33 – 37…”

Section: Introductionmentioning

confidence: 99%

β blockers for elective surgery in elderly patients: population based, retrospective cohort study

Redelmeier

Scales

Kopp

2005

BMJ

135

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Objective To test whether atenolol (a long acting blocker) and metoprolol (a short acting blocker) are associated with equivalent reductions in risk for elderly patients undergoing elective surgery. Design Population based, retrospective cohort analysis. Setting Acute care hospitals in Ontario, Canada, over one decade. Participants Consecutive patients older than 65 who were admitted for elective surgery, without symptomatic coronary disease. Main outcome measure Death or myocardial infarction. Results 37 151 patients were receiving atenolol or metoprolol before surgery, of which the most common operations were orthopaedic or abdominal procedures. As expected, the two groups were similar in demographic characteristics, medical therapy, and type of surgery. 1038 patients experienced a myocardial infarction or died, a rate that was significantly lower for patients receiving atenolol than for those receiving metoprolol (2.5% v 3.2%, P < 0.001). The decreased risk with atenolol persisted after adjustment for measured demographic, medical, and surgical factors; extended to comparisons of other long acting and short acting blockers; was accentuated in analyses that focused on patients with the clearest evidence of blocker treatment; and reflected the immediate postoperative interval. Conclusions Patients receiving metoprolol do not have as low a perioperative cardiac risk as patients receiving atenolol, in accord with possible acute withdrawal after missed doses.

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“…2 Patients are at risk if they stop taking their prescribed SSRI, if the antidepressant is discontinued by their healthcare provider without tapering, or if they're made N.P.O. 2 Patients are at risk if they stop taking their prescribed SSRI, if the antidepressant is discontinued by their healthcare provider without tapering, or if they're made N.P.O.…”

Section: Ssri Discontinuation Syndromementioning

confidence: 99%

The dark side of SSRIs

Inott¹

2009

Nursing Management

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The of SSRIs Learn how to recognize medical and surgical complications associated with these commonly used antidepressants.By Theresa J. Inott, RN, MSN selective serotonin reuptake inhibitors F orty-eight hours after undergoing transurethral resection of the prostate (TURP), PeterAlthouse, 58, develops nausea and intermittent vomiting, followed by chills, dizziness, and tremors. He's anxious and irritable.Concerned that Mr. Althouse is exhibiting signs and symptoms of a serious postoperative complication, you obtain blood specimens and send them to the lab. His complete metabolic profile and complete blood cell count are within normal limits, and additional diagnostic testing rules out a bacterial infection or respiratory complication.Mr. Althouse has no history of alcohol or drug abuse. Two years earlier, however, he'd been prescribed paroxetine for major depressive disorder. Now when you question him further, he says he stopped taking the drug the day before his admission because he was told not to take anything by mouth after midnight. Based on his clinical condition and history of abruptly stopping a selective serotonin reuptake inhibitor (SSRI), you suspect that Mr. Althouse is suffering from SSRI discontinuation syndrome.More than 20 million American adults experience some form of a mood disorder. 1 The most common drugs prescribed for these conditions are SSRIs, and many patients who take these medications, like Mr. Althouse, are admitted to medical or surgical settings for other conditions. In this article, I'll describe complications of SSRIs that you might see in a patient like Mr. Althouse, and how to intervene.

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Discontinuation and reinstitution of medications during the perioperative period

Cited by 47 publications

References 0 publications

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

β blockers for elective surgery in elderly patients: population based, retrospective cohort study

The dark side of SSRIs

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