Venugopal P
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10 Mar 2023 08:34:24 AMPatients on Preoperative Medications – What urologists must know?
Dear All,
We Urologists treat many patients with comorbidities.
Many of our patients are on Anticoagulants and antiplatelets.
There is considerable controversy regarding whether such medications need to be
stopped or can be continued in a patient undergoing Urological Procedures. The
controversy extends even for patients who need Emergency Surgery.
I am providing some literature from which one can get fairly
detailed information as regards the ‘Dos and Don’ts’ concerning this
controversy.
To commence with I am providing an ‘Overview of the
coagulation system’.
https://www.ijaweb.org/article.asp?issn=0019-5049;year=2014;volume=58;issue=5;spage=515;epage=523;aulast=Palta
(PDF available) or
https://www.ijaweb.org/temp/IndianJAnaesth585515-1293238_033532.pdf
There are several articles
addressing this issue and few of them are given below.
https://www.auanet.org/guidelines/anticoagulation-and-antiplatelet-therapy
https://bjui-journals.onlinelibrary.wiley.com/doi/pdf/10.1111/bju.13131
(Downloadable PDF available)
https://www.karger.com/Article/PDF/447214
https://journals.sagepub.com/doi/pdf/10.1177/2051415817728612
Read together
should enable us to have a good idea as to the prevailing knowledge.
Diabetes
is a common ailment many of our patients have and appropriate treatments with
both Injectables and Oral are there in current practice.
Similarly,
Patients are many Drugs aimed at relieving Urological problems when they come
for the needed surgical treatments. There is not much evidence as whether these
drugs can be continued or need to be stopped prior to undertaking Urological
Procedures. An article from Mayo Clinic Proceedings addresses these issues. I
am providing the tables accompanying the article so that we have an
understanding the ‘Dos and Don’ts’.
One
aspect which is important not taken up is ‘Preop, Periop and Postop management
of Pheochromocytoma’. This is an important aspect that all need to know in
detail though Pheo’s is not that frequent.
I am
sure these informations provided will help all of us in mangling patients with
several medications.
With
warm Regards,
Venu
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