A 59-year-old man is planning to undergo a coronary aery bypass. He has osteoahritis and consumes nonsteroidal anti-inflammatory drugs (NSAIDs) for the pain. Which of the following is the most appropriate treatment prior to surgery to minimize his risk of bleeding from his NSAID use?
Begin vitamin K 1 week prior to surgery.
Give FFP few hours before surgery
Stop the NSAIDs 1 week prior to surgery.
Stop the NSAIDs 3 to 4 days prior to surgery.
NSAIDs such as aspirin block platelet function by causing a reversible defect in the enzyme cyclooxygenase. Unlike aspirin which permanently acetylates cyclooxygenase and leaves affected platelets dysfunctional throughout their 7-day life span, NSAIDs cause a reversible defect that lasts 3 to 4 days. Therefore, the patient's platelets will be functional for surgery if he stops taking the NSAIDs 3 to 4 days prior to the date of surgery. The patient would not benefit from FFP or vitamin K since he does not have problems with his clotting factors.
Preoperative assessment and monitoring in anaesthesia