Prescribing Safety Assessment (PSA) Practice Exam

What is the typical recommendation for managing anticoagulants before surgery?

1. Stop 4 weeks before surgery

2. Continue treatment regardless

3. Stop just before surgery

4. Stop 2 days before surgery

The correct answer is: Stop just before surgery

The recommendation to stop anticoagulants just before surgery often aligns with the principle of minimizing bleeding risks during surgical procedures while still managing the underlying conditions that necessitate anticoagulation. Certain anticoagulants can have a short half-life, meaning their effects can wear off relatively quickly after discontinuation. For procedures with a high risk of bleeding, it's typically advised to stop anticoagulant medications a specific period prior to surgery—often 24-48 hours before—depending on the type of anticoagulant, the surgical procedure's bleeding risk, and the patient's individual health status. Stopping them just before surgery allows for the medication's pharmacologic effects to diminish, thus reducing the likelihood of excessive bleeding while balancing the risk of thromboembolic events if anticoagulation is halted too long. In contrast, recommendations to stop anticoagulants weeks in advance or just before surgery do not strategically address both the need for adequate anticoagulation and the need to minimize bleeding risk effectively. The approach may vary depending on the specific anticoagulant used and the patient’s clinical situation, highlighting the importance of individualized patient management in presurgical assessments.