ERAS Society's Guidelines on Perioperative Care: Part 1 - Preoperative Care

6. Reversal of antithrombotic medications
Regarding Anticoagulants (Warfarin, DOACs, Heparin/Enoxaparin), the experts strongly recommend, “Strongly consider reversal of home anticoagulation medications when major surgical intervention is planned. This decision should be based on both the patient’s risk of procedure-related bleeding and the risk of thromboembolism.”
For Platelet inhibitors: (including Aspirin, Clopidogrel, Dipyridamole, Ticagrelor), they recommend, “Consider platelet transfusion in patients taking antiplatelet therapy when the planned procedural bleeding risk is high. In patients with a strong indication for antiplatelets, specialty consultation should be obtained for perioperative co-management of these medications.”

Unlike the recommendation of anticoagulants which was strong, the recommendation for platelet inhibitors was weak.

7. Assessment of venous thromboembolism risk

The expert panel strongly recommend, “Patients should be risk assessed with a validated tool for VTE risk on admission. If pharmaceutical prophylaxis is not possible mechanical prophylaxis should be used. Reassessment should occur daily postoperatively. ”

8. Pre-anesthetic medication—anxiolysis and analgesia

The team of experts strongly recommend,

• “Sedative medication should be avoided preoperatively to avoid the risk of micro-aspiration, hypoventilation and delirium.
• Analgesia should be given to alleviate the patient’s pain and stress.
• Multi modal opioid-sparing analgesia should be titrated to effect to maximize comfort and minimize side-effects.”