From the Guidelines
Zejula (niraparib) should be held before surgery to minimize potential risks associated with bleeding and wound healing. The decision to hold Zejula is based on its mechanism of action as a PARP inhibitor, which can affect platelet function and bone marrow activity, potentially increasing the risk of bleeding and interfering with wound healing 1. When considering the management of patients on Zejula who are undergoing surgery, it's crucial to balance the risks of bleeding and wound complications against the need to maintain continuity of cancer treatment. Key factors to consider include the type of surgery, the patient's overall health status, and the specific risks associated with Zejula in the context of surgery. Given the potential for Zejula to impact wound healing and bleeding risk, it is recommended to discontinue Zejula at least 7 days before planned surgery, although the exact timing may need to be individualized based on the specific clinical circumstances and in consultation with both the oncologist and surgeon 1. After surgery, Zejula can usually be resumed once adequate healing has occurred, typically 2-4 weeks post-operation, but this should be determined on a case-by-case basis considering the extent of surgery and healing progress. Patients should not stop taking Zejula without medical guidance to ensure that cancer treatment needs are balanced with surgical safety. When restarting Zejula after surgery, patients should resume at their previous dose unless otherwise directed by their oncologist. It's also important to note that while the provided evidence primarily discusses anticoagulants like dabigatran, rivaroxaban, and apixaban, the principles of managing medications that can affect bleeding and wound healing around the time of surgery can be applied to other agents like Zejula, emphasizing the need for careful consideration and planning in the perioperative period.
From the Research
Zejula (Niraparib) and Surgery
- There is no direct evidence in the provided studies that specifically addresses whether Zejula (niraparib) should be held before undergoing surgery 2, 3, 4, 5, 6.
- The studies primarily focus on the efficacy and safety of niraparib in various cancer treatments, including metastatic castration-resistant prostate cancer, advanced ovarian cancer, and lung cancer.
- However, it is essential to consider the potential risks and benefits of continuing or discontinuing niraparib treatment before surgery, taking into account the patient's individual circumstances and the type of surgery planned.
- Some studies mention the management of adverse events associated with niraparib, such as hematologic events, gastrointestinal events, and fatigue, which may be relevant when considering surgery 6.
- Healthcare professionals should consult the prescribing information and relevant clinical guidelines to make informed decisions about the use of niraparib in patients undergoing surgery.