I get many requests for preoperative physical exams from the patients in my rural health-care clinic. Does an individual undergoing cataract surgery with standby or local anesthesia need a full workup if he or she has been stable on current medications, regardless of medical history? Should warfarin (Coumadin) be stopped before cataract surgery? If so, how many days prior to the procedure is recommended? — Colette Thompson, FNP, Lexington, Ga.

Cataract surgery that is anticipated to the anterior chamber only is considered a low-risk procedure that does not require stopping warfarin, dabigatran (Pradaxa) or aspirin. However, a procedure that is anticipated to include the posterior chamber carries a high risk for bleeding within a closed space, and all anticoagulants need to be stopped 10 days prior.

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If clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta) are on your patient’s medication list, please clarify the last stent placement before stopping for non-life-threatening surgeries. Drug-eluting coronary artery stents must be protected for one year before stopping for elective surgeries. — Maria Kidner, DNP, FNP-C (157-4)

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