When should a patient discontinue antiplatelet therapy before surgery?

Discontinuing antiplatelet therapy before surgery is crucial to balance the risk of bleeding during the procedure with the risk of thromboembolic events after stopping the medication. The chosen timeframe of one week prior to surgery is often recommended for specific antiplatelet agents, particularly those with a longer half-life or more profound effects on platelet function.

The rationale behind discontinuing therapy a week in advance is to allow sufficient time for the effects of the antiplatelet agent to diminish, thereby reducing the risk of excessive bleeding during the surgical procedure. It also provides an opportunity for the patient's platelet function to recover sufficiently, ensuring that they can form clots effectively after surgery, which is vital for healing and minimizing postoperative complications.

Other timeframes like 24 hours or 48 hours might not adequately allow for the recovery of platelet function in patients, depending on the specific agent used and the patient's physiology. Similarly, waiting two weeks may unnecessarily increase the risk of thrombotic events, which is particularly concerning for patients who have a high risk of clot formation. Overall, the one-week guideline strikes a balance between managing the risks of both bleeding and thrombosis effectively.