Perioperative Management of Iguratimod for Elective Surgery
Recommended Timing for Discontinuation
Iguratimod should be discontinued 24 hours before low-to-moderate bleeding risk procedures and 48-72 hours before high bleeding risk procedures to minimize perioperative bleeding complications. 1
Bleeding Risk Assessment
High bleeding risk procedures (requiring 48-72 hours discontinuation):
- Major vascular surgery
- Cardiac surgery
- Intracranial or spinal surgery
- Surgery in highly vascular organs
- Neuraxial anesthesia or epidural procedures 1
Low-to-moderate bleeding risk procedures (requiring 24 hours discontinuation):
- Arthroscopy
- Cutaneous/lymph node biopsies
- Foot/hand surgery 1
Rationale for Discontinuation
- Iguratimod has been associated with bleeding complications, particularly when used with other medications affecting hemostasis 2
- A peculiar hemorrhage risk has been observed in patients treated concomitantly with iguratimod and warfarin potassium 2
- Gastric bleeding or gastric perforation requires careful attention, especially in patients with concomitant use of both NSAIDs and oral prednisolone 2
Resumption After Surgery
- Resume iguratimod 24 hours after low-to-moderate bleeding risk procedures 1
- Resume iguratimod 48-72 hours after high bleeding risk procedures 1
- Ensure adequate hemostasis has been achieved before restarting therapy 1
Special Considerations
- For emergency procedures, the management approach should be determined through consultation with specialists 1
- Patients on concomitant anticoagulant therapy require special attention due to potentially increased bleeding risk 2
- Monitor for signs of bleeding complications when resuming therapy 2
- The approach to perioperative management of iguratimod follows similar principles to other medications that may affect bleeding risk 1
Comparison with Other Antiplatelet/Anticoagulant Medications
- Unlike some antiplatelet agents (e.g., clopidogrel requiring 5 days discontinuation), iguratimod requires shorter discontinuation periods 3
- Similar to fenofibrate in discontinuation timing recommendations 1
- Unlike warfarin, which may require bridging therapy in high-risk patients, iguratimod typically does not require bridging 3
Common Pitfalls to Avoid
- Failing to recognize the increased bleeding risk when iguratimod is combined with anticoagulants, especially warfarin 2
- Not accounting for gastric bleeding risk in patients also taking NSAIDs and prednisolone 2
- Resuming therapy too early after high bleeding risk procedures 1
- Not communicating the medication discontinuation plan to all members of the healthcare team 1