Medications to Hold Before I&D Surgery Tomorrow
You should hold clopidogrel (Plavix) starting immediately—ideally it should have been stopped 5 days before surgery, but since your procedure is tomorrow, stop it now. Continue aspirin 81 mg through the day of surgery. All other medications can be continued.
Critical Medication: Clopidogrel (Plavix)
Clopidogrel must be discontinued because incision and drainage (I&D) is a surgical procedure with significant bleeding risk 1, 2. The FDA label explicitly states that clopidogrel should be interrupted for 5 days prior to surgery with major bleeding risk, as it inhibits platelet aggregation for 7-10 days 3. While ideally you needed 5 days of discontinuation 2, 4, stopping it now (even if less than 5 days) will provide some reduction in bleeding risk.
Why This Matters for Your Surgery
I&D procedures involve cutting into infected tissue and creating drainage, which carries substantial bleeding risk. Clopidogrel irreversibly blocks platelet function, and continuing it significantly increases your risk of:
- Excessive intraoperative bleeding
- Need for blood transfusions
- Surgical re-exploration for bleeding complications 4, 5
Aspirin: Continue Through Surgery
Continue your aspirin 81 mg including the morning of surgery 2, 6. Current guidelines support continuing low-dose aspirin for most surgical procedures because:
- The cardiovascular protection benefit outweighs bleeding risk for patients with established cardiovascular disease (which you have, given you're on dual antiplatelet therapy)
- Low-dose aspirin (81 mg) has acceptable bleeding risk even during surgery 2
- Stopping aspirin increases your risk of heart attack or stroke 2, 6
The 2011 Canadian Cardiovascular Society guidelines specifically state that aspirin can be continued for most noncardiac surgeries in patients at high cardiovascular risk 2.
All Other Medications: Continue
Continue all remaining medications through surgery:
- Acetaminophen-codeine (Tylenol #3): No bleeding risk; continue as needed for pain
- Allopurinol: No perioperative concerns; continue
- Clotrimazole cream & hydrocortisone rectal cream: Topical agents with no systemic effects; continue
- Levothyroxine: Must be continued to maintain thyroid function; take morning of surgery with small sip of water
- Losartan: Blood pressure medication; generally continued perioperatively unless instructed otherwise by anesthesia
- Omeprazole: Continue—actually protective for gastric bleeding risk from aspirin 3
- Polyethylene glycol (Miralax): Can continue as needed
- Rosuvastatin: Continue—no bleeding risk and may have cardiovascular protective effects
- Tamsulosin: Continue—no bleeding concerns
- Tramadol: Continue as needed for pain management
Important Caveats
Drug Interaction Alert
Your omeprazole may reduce clopidogrel's effectiveness when you restart it after surgery 3, 7. The FDA label warns against this combination. However, do not stop omeprazole now—it provides important gastric protection while you're on aspirin. Discuss with your cardiologist after surgery whether to switch to a different proton pump inhibitor (like pantoprazole) or use an H2-blocker instead.
Post-Operative Restart
- Clopidogrel: Resume as soon as adequate hemostasis is achieved, typically 24 hours post-operatively if no ongoing bleeding 8, 3
- Discuss exact restart timing with your surgeon before leaving the OR
Critical Safety Point
Do not stop both aspirin AND clopidogrel together unless explicitly instructed by your cardiologist. If you have coronary stents (especially drug-eluting stents placed within the last 12 months), stopping both antiplatelet agents dramatically increases your risk of stent thrombosis, heart attack, and death 2, 4. This is why continuing aspirin while holding only clopidogrel is the recommended approach 1.
Confirm With Your Surgical Team
Call your surgeon's office today to confirm they are aware you're on dual antiplatelet therapy and verify the plan for clopidogrel discontinuation and aspirin continuation.