Table 1.

Drugs that May Increase Surgical Blood Loss.

Drugs That Should Be Stopped Prior to Surgery
Drug Class	Mechanism of Action	Drug Names	Minimum Cessation Timea
NSAIDs	Nonselective COX inhibition *Selective COX 2	Diclofenac, Ibuprofen, Celecoxib*	1 day
		Indomethacin, Ketorolac, Etodolac, Sulindac, Naproxen	3 days
		Piroxicam	7 days
		Aspirinb	7 days
Platelet Inhibitors	Irreversible ADP receptor inhibition *Reversible	Clopidogrel, Prasugrel	7 days
		Ticagrelor*	5 days
		Ticlopidine	14 days
Anticoagulants	Irreversibly inhibit thrombin	Low-molecular-weight heparin	1 day
		Unfractionated heparin	4-5 hours
	Reversibly inhibit thrombin	Dabigatran, Rivaroxaban, Apixaban, Endoxaban	3 days
	Vitamin K inhibitor	Warfarin	5 daysc

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; COX, cyclo-oxygenase; ADP, adenosine diphosphate.

^a Minimum cessation time is based on reducing the risk of intraoperative bleeding.

^b Aspirin is also an irreversible platelet inhibitor.

^c Must check international normalized ratio of 1.4 or less.

*The asterisk in each section refers to the asterisk in the next column.