• Cardiovascular drugs: Clopidogrel should be stopped 7 days before surgery, warfarin should be (generally) stopped 5 days before surgery and instead patients should be on low molecular weight heparin until the night before, ACE inhibitors should be stopped the day before surgery.
  • Emergancy surgery warfarin management: stop warfarin, if INR is more than 1.5 give 5mg IV vitamin K and recheck in 12 hours to ensure it is less than 1.5
• Diabetes drugs: Insulin should be held on the day of surgery (only the short-acting preparations), sulfonylureas should be held on the day of surgery (due to the risk of hypoglycaemia). Note that metformin can be given as normal for short procedures. For longer procedures when the patient is not eating and drinking for several days metformin should be held and variable-rate insulin prescribed.
• The pill should be stopped 4-6 weeks before surgery, and re-started at least 2 weeks after surgery (when the patient is mobile). This reduces the risk of DVT.
• There is a risk of AKI in patients taking ACE-i who are nil by mouth, so stop ACE-i the day before the surgery