How long before major orthopedic surgery should a patient on anticoagulant or antiplatelet medication (GLP) be stopped?

Timing for Stopping GLP-1 Agonists Before Major Orthopedic Surgery

Critical Clarification

The question appears to contain a terminology error: "GLP" likely refers to GLP-1 receptor agonists (diabetes/weight loss medications like semaglutide), NOT anticoagulant or antiplatelet medications. The evidence provided focuses entirely on anticoagulants and antiplatelet agents, which are completely different drug classes.

If the Question is About GLP-1 Agonists (Semaglutide, Dulaglutide, etc.)

GLP-1 receptor agonists should be stopped at least 1 week before major orthopedic surgery due to delayed gastric emptying and aspiration risk during anesthesia. This is standard anesthesia practice, though not covered in the provided evidence.

If the Question is About Antiplatelet Agents (Likely Intended Meaning)

For Clopidogrel (P2Y12 Inhibitor)

Stop clopidogrel 5 days before major orthopedic surgery to minimize bleeding risk while allowing adequate time for platelet function recovery. 1

• The FDA label explicitly states: "When possible, interrupt therapy with clopidogrel for five days prior to surgery with a major risk of bleeding" 1
• Clopidogrel inhibits platelet aggregation for the lifetime of the platelet (7-10 days), but 5 days allows sufficient new platelet production to restore hemostasis 1
• The American College of Chest Physicians recommends discontinuing clopidogrel 5 days before surgery 2

For Aspirin

Continue aspirin perioperatively for patients with moderate-to-high cardiovascular risk; stop 7-10 days before surgery only for low cardiovascular risk patients. 2

• The risk of coronary thrombosis from aspirin withdrawal typically exceeds the risk of surgical bleeding when maintaining it 3, 4
• For orthopedic procedures specifically, aspirin continuation is generally safer than discontinuation in patients with cardiovascular disease 2

For Dual Antiplatelet Therapy (DAPT)

If the patient has a coronary stent, defer elective orthopedic surgery for ≥6 weeks after bare-metal stent or ≥6 months after drug-eluting stent placement. 2

• If surgery cannot be deferred, continue both antiplatelet agents perioperatively rather than stopping them 2
• The thrombotic risk of stopping DAPT prematurely far exceeds bleeding risk 3, 4

For Other P2Y12 Inhibitors

• Prasugrel: Stop 7 days before surgery 2
• Ticagrelor: Stop 3-5 days before surgery 2

Postoperative Resumption

Resume antiplatelet therapy within 24 hours after surgery once adequate hemostasis is achieved. 2

• Early resumption is critical to prevent thrombotic complications 2
• The FDA label emphasizes restarting clopidogrel "as soon as possible" after temporary discontinuation 1

Common Pitfalls

• Do not use heparin or LMWH bridging for antiplatelet agents - this does not protect against coronary or stent thrombosis 3
• Do not routinely stop aspirin - the default should be continuation unless bleeding risk is exceptionally high and cardiovascular risk is low 2, 4
• Major orthopedic surgery carries moderate-to-high bleeding risk, which supports the 5-day discontinuation window for clopidogrel 5