Anticoagulants prior to surgery (BAHNO recommendations)
- Clopidogrel should be discontinued 5 days preoperatively
- Aspirin should be continued without interruption
- Warfarin should be discontinued 5 days preoperatively
- Warfarin given for uncomplicated atrial fibrillation can be stopped with no added precautions
- Warfarin stopped in patients with previous thromboembolic disease or artificial heart valves they require SC heparin therapy for 5 days perioperatively (self administered)
Day before surgery
- Most patients are admitted the night before
- Medications should be prescribed
- Anticoagulant management as above
- Some units start on a proton pump inhibitor pre operatively (check local protocol)
- Ensure recent bloods (generally within last 2 weeks)
- Try to avoid taking bloods for fear of damaging veins being used for flap anastamosis
- Ensure group and save in date
- If radial flap ensure that the arm is marked with a pen to ensure no one takes blood from it
- Ensure consented
Oral hypoglycaemics
- Omit on the day of surgery and restarted when normal diet is resumed.
Antihypertensives
- Omit antihypertensives on day of surgery and restart following day
Venous thromboembolism prophylaxis
- All patients should be prescribed thigh length graduated elastic compression stockings (TEDS) on admission.
- All patients should receive intraoperative intermittent pneumatic compression.
- All patients should be given prophylactic dose subcutaneous low molecular weight heparin started on admission and continued until discharge.
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