1 Preoperative Preparation
Preoperative Medical Evaluation
Medical History
Medications
Anticoagulation/Antiplatelet Therapy
The clinician needs to find out which medications the patient is taking in order to determine if there will be an increased risk of bleeding in the intraoperative or postoperative period. This includes warfarin, aspirin, NSAIDs, clopidogrel, and low-molecular-weight heparin. For larger surgeries, one might query patients about their use of any vitamin, herbal, or other over-the-counter supplements because some of these can alter the coagulation profile (see Box 1-1).
Box 1-1
Supplements That Alter Coagulation
Source: Adapted from Dinehart SM. Dietary supplements: Altered coagulation and effects on bruising. Dermatol Surg. 2005;31:819–826.
Aspirin therapy was not an independent risk factor for bleeding. The researchers concluded that “most postoperative bleeds were inconvenient but not life threatening, unlike the potential risk of thromboembolism after stopping warfarin or aspirin.” They recommended not to discontinue aspirin before skin surgery.1