From the Guidelines
Cilostazol should be discontinued at least 48 hours (2 days) before elective surgery. This recommendation is based on the medication's antiplatelet effects and its half-life of approximately 10 hours, as noted in the American College of Chest Physicians evidence-based clinical practice guidelines 1. Cilostazol inhibits phosphodiesterase III, which prevents platelet aggregation and causes vasodilation. Continuing cilostazol too close to surgery increases the risk of excessive bleeding during and after the procedure. The 48-hour window allows time for the drug's effects to sufficiently diminish and for platelet function to normalize.
Some key points to consider when discontinuing cilostazol before surgery include:
- The half-life of cilostazol is 10 hours, which suggests that its effects will diminish relatively quickly after discontinuation 1
- The optimal timing of antiplatelet drug interruption before surgery is not well established, but stopping 7 to 10 days before surgery may allow complete elimination of the antiplatelet effect 1
- For emergency surgeries where this discontinuation period isn't possible, the surgical team should be informed about the patient's cilostazol use to prepare for potential increased bleeding
- Patients should always consult with both their prescribing physician and surgeon before stopping any medication, as individual circumstances may require different timing
After surgery, cilostazol can typically be resumed once adequate hemostasis is achieved and the surgeon approves, usually within 24-48 hours post-operation for most procedures. It is essential to weigh the risks of bleeding against the risks of thromboembolic events when deciding on the timing of cilostazol discontinuation and resumption 1.
From the Research
Discontinuation of Cilostazol Prior to Surgery
- The optimal duration for discontinuing cilostazol prior to surgery is not clearly established in the provided studies.
- A study from 2024 2 found that antiplatelet agents, including cilostazol, were discontinued from 3 to 5 days by 18%-23% of physicians for low-risk procedures, approximately 60% of physicians for moderate or intermediate-risk procedures, and over 90% of physicians for high-risk procedures.
- However, another study from 2006 3 noted that there are no trials available concerning surgery and cilostazol, and therefore, no specific recommendation can be made.
- It is essential to consider the individual patient's risk factors and the type of surgery being performed when deciding whether to discontinue cilostazol and for how long.
- Studies have shown that cilostazol has a unique mechanism of action and a low rate of bleeding complications 4, 5, 6, but the decision to discontinue it prior to surgery should be made on a case-by-case basis.