What preparations and medication restrictions are necessary before undergoing hip surgery, including any vitamins or supplements that should be avoided?

Preparation for Hip Surgery: Medication Management and Restrictions

For hip surgery preparation, you should stop taking aspirin 7 days before surgery, clopidogrel 7-10 days before, warfarin 5 days before (aiming for INR <1.5), and direct oral anticoagulants 2-4 days before surgery depending on the specific medication and your kidney function. 1, 2

Anticoagulant and Antiplatelet Medications

Warfarin

• Stop warfarin 5-6 days before surgery 1
• Target INR should be <2 for surgery and <1.5 for spinal/neuraxial anesthesia 1
• Small amounts of vitamin K may be used to reverse warfarin's effects if needed 1
• Warfarin should be resumed approximately 24 hours after surgery 1

Direct Oral Anticoagulants (DOACs)

• Apixaban (Eliquis): Stop 2 days before surgery 1, 2
• Rivaroxaban (Xarelto): Stop 3 days before surgery 1, 2
• Dabigatran: Stop 3-4 days before surgery if you have impaired kidney function (creatinine clearance <50 mL/min) 1
• Longer interruption may be needed for patients with severe kidney or liver impairment 1

Antiplatelet Medications

• Aspirin: Stop 7 days before surgery unless prescribed for unstable angina or recent/frequent transient ischemic attacks 1, 2
• Clopidogrel (Plavix): Stop 7-10 days before surgery 1, 2
• Note: If you have drug-eluting coronary stents, clopidogrel is generally not stopped on admission 1

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• Stop NSAIDs before surgery according to the following timeline 2:
  • 1 day before: Diclofenac (Voltaren), Ibuprofen (Advil, Motrin), Ketorolac (Toradol)
  • 2 days before: Etodolac (Lodine), Indomethacin (Indocin)
  • 4 days before: Meloxicam (Mobic), Naproxen (Aleve, Naprosyn)
  • 6 days before: Oxaprozin (Daypro)
  • 10 days before: Piroxicam (Feldene)

Vitamin and Supplement Considerations

• Iron supplements may be beneficial before surgery, especially if your hemoglobin is below 12 g/dL 3
• Iron supplementation can help optimize hemoglobin levels and reduce post-operative hemoglobin drop 3
• Vitamin K-containing supplements should be avoided if you're on warfarin as they can interfere with its effectiveness 4
• Cranberry juice or products should be avoided if you're on warfarin 4

Special Considerations

Diabetes Management

• Hospital guidelines for perioperative diabetes management should be followed 1
• Hyperglycemia alone is not a reason to delay surgery unless you are ketotic or dehydrated 1

Cardiac Conditions

• If you have a heart murmur or suspected valvular heart disease, inform your surgical team 1
• Echocardiography may be indicated in certain cases but should not delay surgery 1

Bridging Therapy

• If you're at high risk for blood clots, low-molecular-weight heparin (LMWH) bridging therapy may be used during the period when warfarin is stopped 1
• LMWH typically starts 36 hours after the last warfarin dose 1
• The last dose of LMWH should be administered 24 hours before surgery using half the normal daily dose 1

Post-Surgical Considerations

• Anticoagulant medication will typically be resumed 24 hours after surgery 1
• Thromboprophylaxis with LMWH is often continued for 7-10 days after hip surgery 1
• For high-risk patients, LMWH may be continued for a minimum of 4 weeks after discharge 1

Remember to always follow the specific instructions provided by your surgical team, as they may customize these guidelines based on your individual medical history and risk factors 1.