Surgery and aspirin: what protocol with APS?

[luisal]

Hello everyone,I'll be intervened on April 22 of strabismus, to correct a previous surgery of orbit decompression due to Thyroid Eye Disease.

For this new surgery the doctor will use 16 mg. of Dexamethasone IV to prevent eye inflamnation. I have a diagnosis of Double APS since 2007, with no thrombosis and taking 100 daily mg of Aspirin. For the past 2 months I've been following a treatment based on Methylprednisolone infusions (2.5 g) and Oral prednisone (of which I'm currently taking 5 mg. Per day).

I have doubts if I should stop all together Aspirine and what protocol to follow for surgery when having APS.

Thanks in advance for your guidance.

[GinaD]

Has your eye doctor ever done similar surgeries on other APS patients on asperin? And/or has your doctor consulted with another doc who has? In other words, is there a proven protocol your doctor can mirror? OR, you might pause the asperin and get an injectible to use for a day or so after the surgery. I have never been on just asperin for my APS, though I know it has worked for many. A bridgiing protocol is what most of us on more aggressive blood thinners do. What does your APS diagnosing doctor think?

[luisal in reply to GinaD]

Hi GinaD, thanks for your answer. My eye doctor has no previous experience with an APS patience. I have asked my hematologists but I usually check with this network just in case there are new emerging practices. There is always a gap with less developed countries.I have read in the past postings recommending Clexane as a substitute. Is this what you have in mind?

[user666 in reply to luisal]

Your team will have the best answer for your particular case not a forum. The eye surgeon knows the risks aspirin will cause for his surgery and your hematologist knows the risk to benefit ratio of going off aspirin for a few days. Without a history of a clot using lovenox or heparin may be far more risky than not being on anything. Let your team figure out your safest way to proceed.

[HollyHeski Administrator in reply to luisal]

Hi, you are totally right checking with your hematologist, clexane is usually used as a substitute for warfarin(both anticogerations), as part of the anticoageration bridging plan, aspirin and clopidogrel are anti platelets and work differently.I am on daily clexane, aspirin and clopidogrel as a combination treatment for my APS, when I have had surgery, my hematologist has given me a written bridging plan for me and my surgeons to follow.

Your hematologist and eye surgeon need to talk to each other and consult with you about the aspirin and risks involved. Aspirin can stay in the system up to 3 days so that may help with your plan.

Wishing you success with your surgery xx

[luisal in reply to HollyHeski]

Many thanks for your guidance and well wishes, all the best

[MaryF Administrator]

HI, it is fine to ask a question such as this on this forum, Aspirin is in the system for quite some time, three days I believe, and if I were you I would be ringing or writing to your main consultant, it is really important that they answer these questions for you as it is important to have the correct medical advice, many on here do ask such questions before a procedure. MaryF

[luisal in reply to MaryF]

Many thanks MaryF. I totally agree with your advice.

[luisal]

Hello MaryF and Holliheski,The protocol my hematologist Dr. Cinara

is recomnending for the procedure (also agreed upon by the ophtalmologist) is the following:

1 to pause aspirin 5 days prior to the intervention

2 40 mg of Clexane the day before the procedure and 12 hours after.

3. Reinitiate aspirin the day before surgery..

Thanks again for your support

[HollyHeski Administrator in reply to luisal]

So glad you have everyone in agreement of a good plan and being looked after.Hope surgery all goes well xx