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Clin Colon Rectal Surg 2023; 36(03): 210-217
DOI: 10.1055/s-0043-1761156
Review Article

Perioperative Assessment and Optimization in Major Colorectal Surgery: Medication Management

William J. Kane
1   Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
,
Puja Shah Berry
2   Department of General and Colorectal Surgery, WellSpan Surgical Specialists, York, Pennsylvania
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Abstract

The colorectal surgeon is often faced with medications that can be challenging to manage in the perioperative period. In the era of novel agents for anticoagulation and immunotherapies for inflammatory bowel disease and malignancy, understanding how to advise patients about these medications has become increasingly complex. Here, we aim to provide clarity regarding the use of these agents and their perioperative management, with a particular focus on when to stop and restart them perioperatively. This review will begin with the management of both nonbiologic and biologic therapies used in the treatment of inflammatory bowel disease and malignancy. Then, discussion will shift to anticoagulant and antiplatelet medications, including their associated reversal agents. Upon finishing this review, the reader will have gained an increased familiarity with the management of common medications requiring modification by colorectal surgeons in the perioperative period.

Keywords

colorectal - immunosuppression - biologic therapy - anticoagulation - antiplatelets


Publication History

Article published online:
03 February 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Wong DJ, Roth EM, Feuerstein JD, Poylin VY. Surgery in the age of biologics. Gastroenterol Rep (Oxf) 2019; 7 (02) 77-90
    CrossrefPubMedSearch in Google Scholar
  • 2 Kumar A, Auron M, Aneja A, Mohr F, Jain A, Shen B. Inflammatory bowel disease: perioperative pharmacological considerations. Mayo Clin Proc 2011; 86 (08) 748-757
    CrossrefPubMedSearch in Google Scholar
  • 3 Hicks CW, Wick EC, Salvatori R, Ha CY. Perioperative corticosteroid management for patients with inflammatory bowel disease. Inflamm Bowel Dis 2015; 21 (01) 221-228
    CrossrefPubMedSearch in Google Scholar
  • 4 Lightner AL, Shen B. Perioperative use of immunosuppressive medications in patients with Crohn's disease in the new “biological era”. Gastroenterol Rep (Oxf) 2017; 5 (03) 165-177
    CrossrefPubMedSearch in Google Scholar
  • 5 Lightner AL. Perioperative management of biologic and immunosuppressive medications in patients with Crohn's disease. Dis Colon Rectum 2018; 61 (04) 428-431
    CrossrefPubMedSearch in Google Scholar
  • 6 Prete A, Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ 2021; 374 (1380): n1380
    CrossrefPubMedSearch in Google Scholar
  • 7 Law CC, Bell C, Koh D, Bao Y, Jairath V, Narula N. Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease. Cochrane Database Syst Rev 2020; 10 (10) CD013256
    PubMedSearch in Google Scholar
  • 8 Shah RS, Click BH. Medical therapies for postoperative Crohn's disease. Therap Adv Gastroenterol 2021; 14: 1756284821993581
    CrossrefPubMedSearch in Google Scholar
  • 9 Zakerska-Banaszak O, Łykowska-Szuber L, Walczak M, Żuraszek J, Zielińska A, Skrzypczak-Zielińska M. Cytotoxicity of thiopurine drugs in patients with inflammatory bowel disease. Toxics 2022; 10 (04) 151
    CrossrefPubMedSearch in Google Scholar
  • 10 Weissman S, Chris-Olaiya A, Mehta TI. et al. A novel player: cyclosporine therapy in the management of inflammatory bowel disease. Transl Gastroenterol Hepatol 2019; 4: 67
    CrossrefPubMedSearch in Google Scholar
  • 11 Nickerson TP, Merchea A. Perioperative considerations in Crohn disease and ulcerative colitis. Clin Colon Rectal Surg 2016; 29 (02) 80-84
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 McKenna NP, Lightner AL. Preoperative considerations in inflammatory bowel disease. Surg Clin North Am 2019; 99 (06) 1083-1094
    CrossrefPubMedSearch in Google Scholar
  • 13 Reindl W, Thomann AK, Galata C, Kienle P. Reducing perioperative risks of surgery in Crohn's disease. Visc Med 2019; 35 (06) 348-354
    CrossrefPubMedSearch in Google Scholar
  • 14 Cohen BL, Fleshner P, Kane SV. et al. Prospective cohort study to investigate the safety of preoperative tumor necrosis factor inhibitor exposure in patients with inflammatory bowel disease undergoing intra-abdominal surgery. Gastroenterology 2022; 163 (01) 204-221
    CrossrefPubMedSearch in Google Scholar
  • 15 Parrish AB, Lopez NE, Truong A. et al. Preoperative serum vedolizumab levels do not impact postoperative outcomes in inflammatory bowel disease. Dis Colon Rectum 2021; 64 (10) 1259-1266
    CrossrefPubMedSearch in Google Scholar
  • 16 Poylin VY, Serrato JC, Pastrana Del Valle J, Feuerstein JD. Vedolizumab does not increase perioperative surgical complications in patients with inflammatory bowel disease, cohort study. Intest Res 2022; 20 (01) 72-77
    CrossrefPubMedSearch in Google Scholar
  • 17 Kim JY, Zaghiyan K, Lightner A, Fleshner P. Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study. BMC Surg 2020; 20 (01) 46
    CrossrefPubMedSearch in Google Scholar
  • 18 Yamada A, Komaki Y, Patel N. et al. Risk of postoperative complications among inflammatory bowel disease patients treated preoperatively with vedolizumab. Am J Gastroenterol 2017; 112 (09) 1423-1429
    CrossrefPubMedSearch in Google Scholar
  • 19 Lightner AL, McKenna NP, Alsughayer A. et al. Biologics and 30-day postoperative complications after abdominal operations for Crohn's disease: are there differences in the safety profiles?. Dis Colon Rectum 2019; 62 (11) 1352-1362
    CrossrefPubMedSearch in Google Scholar
  • 20 Garg R, Mohan BP, Ponnada S, Regueiro M, Lightner AL, Click B. Postoperative outcomes after preoperative ustekinumab exposure in patients with Crohn's disease: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34 (05) 691-698
    PubMedSearch in Google Scholar
  • 21 Lightner AL, Kotze PG, Ashburn JH, Remzi FH, Strong SA, Fleshner PR. Report from advances in inflammatory bowel diseases 2019: an update. Dis Colon Rectum 2020; 63 (10) 1355-1357
    CrossrefPubMedSearch in Google Scholar
  • 22 Ackerman RS, Muncey AR, Aldawoodi NN, Kotha R, Getting REG. Cancer immunotherapies: what the perioperative physician needs to know. Curr Oncol Rep 2022; 24 (04) 399-414
    CrossrefPubMedSearch in Google Scholar
  • 23 Yoshimoto T, Yoshikawa K, Higashijima J. et al. Bevacizumab-associated intestinal perforation and perioperative complications in patients receiving bevacizumab. Ann Gastroenterol Surg 2020; 4 (02) 151-155
    CrossrefPubMedSearch in Google Scholar
  • 24 Douketis JD, Spyropoulos AC, Spencer FA. et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e326S-e350S
    CrossrefPubMedSearch in Google Scholar
  • 25 White RH, McKittrick T, Hutchinson R, Twitchell J. Temporary discontinuation of warfarin therapy: changes in the international normalized ratio. Ann Intern Med 1995; 122 (01) 40-42
    CrossrefPubMedSearch in Google Scholar
  • 26 Douketis JD, Spyropoulos AC, Kaatz S. et al; BRIDGE Investigators. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 2015; 373 (09) 823-833
    CrossrefPubMedSearch in Google Scholar
  • 27 Baumgartner C, de Kouchkovsky I, Whitaker E, Fang MC. Periprocedural bridging in patients with venous thromboembolism: a systematic review. Am J Med 2019; 132 (06) 722-732.e7
    CrossrefPubMedSearch in Google Scholar
  • 28 Siegal D, Yudin J, Kaatz S, Douketis JD, Lim W, Spyropoulos AC. Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates. Circulation 2012; 126 (13) 1630-1639
    CrossrefPubMedSearch in Google Scholar
  • 29 Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137 (02) 263-272
    CrossrefPubMedSearch in Google Scholar
  • 30 Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138 (05) 1093-1100
    Search in Google Scholar
  • 31 Omran H, Bauersachs R, Rübenacker S, Goss F, Hammerstingl C. The HAS-BLED score predicts bleedings during bridging of chronic oral anticoagulation. Results from the national multicentre BNK Online bRiDging REgistRy (BORDER). Thromb Haemost 2012; 108 (01) 65-73
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Dunn AS, Spyropoulos AC, Turpie AG. Bridging therapy in patients on long-term oral anticoagulants who require surgery: the Prospective Peri-operative Enoxaparin Cohort Trial (PROSPECT). J Thromb Haemost 2007; 5 (11) 2211-2218
    CrossrefPubMedSearch in Google Scholar
  • 33 Dentali F, Marchesi C, Giorgi Pierfranceschi M. et al. Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. A meta-analysis. Thromb Haemost 2011; 106 (03) 429-438
    PubMedSearch in Google Scholar
  • 34 Hirsh J, Guyatt G, Lewis SZ. Reflecting on eight editions of the American College of Chest Physicians antithrombotic guidelines. Chest 2008; 133 (06) 1293-1295
    CrossrefPubMedSearch in Google Scholar
  • 35 Coons JC, Iasella CJ, Thornberg M. et al. Clinical outcomes with unfractionated heparin monitored by anti-factor Xa vs. activated partial Thromboplastin time. Am J Hematol 2019; 94 (09) 1015-1019
    CrossrefPubMedSearch in Google Scholar
  • 36 Sokolowska E, Kalaska B, Miklosz J, Mogielnicki A. The toxicology of heparin reversal with protamine: past, present and future. Expert Opin Drug Metab Toxicol 2016; 12 (08) 897-909
    CrossrefPubMedSearch in Google Scholar
  • 37 Shaw JR, Li N, Vanassche T. et al. Predictors of preprocedural direct oral anticoagulant levels in patients having an elective surgery or procedure. Blood Adv 2020; 4 (15) 3520-3527
    CrossrefPubMedSearch in Google Scholar
  • 38 Pollack Jr CV, Reilly PA, van Ryn J. et al. Idarucizumab for dabigatran reversal - full cohort analysis. N Engl J Med 2017; 377 (05) 431-441
    CrossrefPubMedSearch in Google Scholar
  • 39 Connolly SJ, Milling Jr TJ, Eikelboom JW. et al; ANNEXA-4 Investigators. Andexanet alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med 2016; 375 (12) 1131-1141
    CrossrefPubMedSearch in Google Scholar
  • 40 Devereaux PJ, Mrkobrada M, Sessler DI. et al; POISE-2 Investigators. Aspirin in patients undergoing noncardiac surgery. N Engl J Med 2014; 370 (16) 1494-1503
    Search in Google Scholar
  • 41 Sessler DI, Conen D, Leslie K. et al; Perioperative Ischemic Evaluation-2 Trial (POISE-2) Investigators. One-year results of a factorial randomized trial of aspirin versus placebo and clonidine versus placebo in patients having noncardiac surgery. Anesthesiology 2020; 132 (04) 692-701
    CrossrefPubMedSearch in Google Scholar
  • 42 Gerstein NS, Albrechtsen CL, Mercado N, Cigarroa JE, Schulman PM. A comprehensive update on aspirin management during noncardiac surgery. Anesth Analg 2020; 131 (04) 1111-1123
    CrossrefPubMedSearch in Google Scholar
  • 43 Khan SU, Singh M, Valavoor S. et al. Dual antiplatelet therapy after percutaneous coronary intervention and drug-eluting stents: a systematic review and network meta-analysis. Circulation 2020; 142 (15) 1425-1436
    CrossrefPubMedSearch in Google Scholar
  • 44 Levine GN, Bates ER, Bittl JA. et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 68 (10) 1082-1115
    CrossrefPubMedSearch in Google Scholar