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Short Summary
Main recommendation: Stop certain weight-loss, diabetes, and blood-thinning medications on specific days before surgery to lower the risk of complications such as aspiration during anesthesia and dangerous bleeding, and restart them once bleeding risk drops. The video, from UCLA Health's Endocrine Surgery team, lists generic and brand names for each drug and gives a timing schedule for stopping them.
Key Points
- GLP-1 receptor agonists (semaglutide, known as Ozempic or Wegovy, and tirzepatide, known as Mounjaro or Zepbound) slow stomach emptying, so food can stay in the stomach and potentially enter the lungs during anesthesia, causing pneumonia.
- SGLT2 inhibitors (empagliflozin/Jardiance, canagliflozin/Invokana, dapagliflozin/Farxiga) and metformin are also on the stop list, with different timing.
- Insulin users need a special plan made with their doctor, because routine fasting before surgery combined with usual diabetes medication can drop blood sugar dangerously low.
- Blood thinners are split into long-acting (warfarin/Coumadin, clopidogrel/Plavix, ticagrelor/Brilinta, and aspirin) and short-acting (apixaban/Eliquis, rivaroxaban/Xarelto) groups, each with its own stop timing.
- Some patients with heart disease may need to keep taking aspirin through surgery; the surgeon decides this case by case.
- Blood thinners are restarted as soon as it is safe, because many patients take them to prevent dangerous clots, such as those caused by atrial fibrillation.
Details Worth Noting
- Concrete instructions:
- GLP-1 drugs (Ozempic/Wegovy, Mounjaro/Zepbound): if taken weekly by injection, stop at least 7 days before surgery. If taken as a daily dose, skip the dose on the day of surgery.
- SGLT2 inhibitors (Jardiance, Invokana, Farxiga): stop 4 days before surgery.
- Metformin: stop 2 days before surgery.
- Insulin by daily injection: do not simply continue usual doses while fasting; get a special written plan from your doctor before surgery.
- Long-acting blood thinners (warfarin/Coumadin, clopidogrel/Plavix, ticagrelor/Brilinta, aspirin): stop 7 days before surgery, unless your doctor says to continue aspirin (for example, some heart disease patients).
- Short-acting blood thinners (apixaban/Eliquis, rivaroxaban/Xarelto): stop 3 days before surgery.
- Restart medications slowly once bleeding risk goes down; the timing depends on the operation, its bleeding risk, and the specific medication.
- The video says a summary table is shown on the web page with all drugs and stop times, but the table itself is not in the transcript.
- The video is aimed at UCLA patients having endocrine surgery on the thyroid, parathyroid, or adrenal glands. Patients at other institutions or with other surgeries should ask their surgeon for specific guidance.
- The presenter notes this video is for UCLA endocrine surgery patients; those at other institutions or having other surgeries may find it a useful general guideline but should ask their own surgeon.
Bottom Line
Know your medication and its stop day before surgery, especially GLP-1 drugs, SGLT2 inhibitors, metformin, insulin, and blood thinners, and confirm the exact plan with your own surgical team.
