Prescribing Safety Assessment (PSA) Practice Exam

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How many weeks before surgery should the COCP pill and HRT be discontinued?

1 week
2 weeks
4 weeks
6 weeks

The correct answer is: 4 weeks

Discontinuation of combined oral contraceptive pills (COCP) and hormone replacement therapy (HRT) prior to surgery is generally advised for the reduction of thromboembolic risk. The recommendation to stop these medications at least 4 weeks before surgery is based on evidence suggesting that the increased risk of venous thromboembolism (VTE) associated with the use of estrogen-containing medications persists even after stopping the pills. By allowing a clear window of 4 weeks, the body has time to return to its baseline coagulation state, thereby lowering the risk of complications during the surgical procedure. This practice is especially important for surgeries associated with a higher risk of VTE, such as orthopedic or major abdominal surgeries. Shorter discontinuation periods may not provide sufficient time for the effects of the medication to diminish, therefore maintaining an elevated risk for potential thrombotic events during and after surgery.