Perioperative Management of Fenofibrate
Fenofibrate should be discontinued 24 hours before surgery for low-to-moderate bleeding risk procedures and 48-72 hours before high bleeding risk procedures due to potential bleeding complications. 1
Bleeding Risk Assessment
The decision to discontinue fenofibrate preoperatively depends on the bleeding risk associated with the surgical procedure:
High Bleeding Risk Procedures (stop fenofibrate 48-72 hours before)
- Major vascular surgery
- Cardiac, intracranial, or spinal surgery
- Surgery in highly vascular organs (kidneys, liver, spleen)
- Any major operation (procedure duration > 45 min)
- Neuraxial anesthesia or epidural injections 1
Low-to-Moderate Bleeding Risk Procedures (stop fenofibrate 24 hours before)
- Arthroscopy
- Cutaneous/lymph node biopsies
- Foot/hand surgery
- Coronary angiography
- GI endoscopy biopsy
- Colonoscopy biopsy
- Abdominal hysterectomy
- Laparoscopic cholecystectomy 1
Minimal Bleeding Risk Procedures (may continue fenofibrate)
- Minor dermatologic procedures
- Ophthalmologic (cataract) procedures
- Minor dental procedures
- Pacemaker or cardioverter-defibrillator device implantation 1
Rationale for Discontinuation
While fenofibrate is not an anticoagulant, there are several reasons to consider discontinuation before surgery:
- Fenofibrate can potentiate the effects of coumarin anticoagulants, potentially increasing bleeding risk 2
- Fenofibrate has pleiotropic effects that may include reducing levels of fibrinogen and various pro-inflammatory markers 3, 4
- Perioperative management of lipid-lowering medications generally follows a cautious approach to minimize potential complications 1
Resumption After Surgery
Resumption of fenofibrate should follow these guidelines:
- For low-to-moderate bleeding risk procedures: Resume fenofibrate 24 hours after surgery 1
- For high bleeding risk procedures: Resume fenofibrate 48-72 hours after surgery 1
Special Considerations
- If the patient is also on anticoagulant therapy, management should be determined by a consensus of the surgeon, anesthesiologist, and other specialists involved in the patient's care 1
- For emergency procedures, consultation with specialists is strongly advised 1
- Patients with hepatic impairment require special attention as fenofibrate is associated with transaminase elevations 2
Common Pitfalls to Avoid
- Failing to distinguish between fenofibrate and anticoagulants: While fenofibrate is not an anticoagulant, it may have some effects on hemostasis that warrant perioperative consideration 3
- Overlooking drug interactions: Fenofibrate can potentiate the effects of coumarin anticoagulants, which requires careful monitoring if both medications are used 2
- Neglecting to restart the medication: Ensure fenofibrate is restarted at the appropriate time postoperatively to maintain lipid control 1
Remember that these recommendations are based on general principles of perioperative medication management, as specific guidelines for fenofibrate are limited. The primary concern is to balance the risk of bleeding against the benefits of continued lipid management.