From the Research
Niacin should typically be held before surgery to minimize the risk of bleeding and ensure optimal surgical outcomes. The decision to withhold niacin before surgery is based on its vasodilatory effects, which can increase the risk of bleeding during surgery 1. Niacin causes peripheral vasodilation by releasing prostaglandins, which can potentially complicate surgical procedures by making it more difficult to control bleeding. Although the provided evidence does not directly address the management of niacin in the perioperative period, the principles of managing medications that affect bleeding risk can be applied.
Key Considerations
- Niacin's vasodilatory effects can increase the risk of bleeding during surgery
- The medication can interact with anesthetic agents and other medications commonly used during surgery
- Patients should inform their surgeon and anesthesiologist about all medications and supplements they are taking, including niacin, during preoperative consultations
- The surgeon may provide specific instructions regarding when to resume niacin after surgery, which typically depends on the type of procedure performed and the patient's recovery progress
Perioperative Management
The management of medications that affect bleeding risk, such as antiplatelet therapy and anticoagulants, is crucial in the perioperative period 2, 3. While niacin is not directly addressed in these studies, the principles of managing bleeding risk can be applied. It is generally recommended to discontinue medications that increase the risk of bleeding before surgery, unless the risk of a major adverse cardiac event exceeds the risk of bleeding.
Evidence and Recommendations
The most recent and highest quality study on the topic of perioperative medication management is from 2019 3. However, this study does not directly address the management of niacin. A study from 2012 provides information on the clinical use of niacin, but does not address its management in the perioperative period 1. Based on the available evidence and the principles of managing bleeding risk, it is recommended to discontinue niacin supplements or medications at least 24-48 hours before a scheduled surgical procedure. Patients should always inform their surgeon and anesthesiologist about all medications and supplements they are taking, including niacin, during preoperative consultations. The surgeon may provide specific instructions regarding when to resume niacin after surgery, which typically depends on the type of procedure performed and the patient's recovery progress.