Safe Steps to Surgery: Dr. Udgeath Dhir’s Expert Guide to Pre-Heart Surgery Medication Management
Heart surgery is a significant life event. Preparing for it goes beyond emotional readiness — it requires careful medical planning too. One of the most critical yet often overlooked steps is managing the medications you take leading up to the operation.
In a highly informative video, Dr. Udgeath Dhir, one of India’s leading cardiac surgeons, shares crucial insights into which medicines need to be stopped before heart surgery to ensure safety and a successful outcome..
Why Managing Medications Before Heart Surgery Matters
Heart surgeries — whether bypasses, valve repairs, or replacements — involve complex procedures with a significant risk of bleeding and complications.
Many medicines that patients normally take for their heart conditions or other issues can interfere with blood clotting, anesthesia, wound healing, or surgical recovery.
Stopping certain medicines at the right time reduces risks such as:
- Excessive bleeding during surgery
- Poor wound healing
- Uncontrolled blood pressure swings
- Drug interactions with anesthesia
- Compromised heart and organ function during surgery
Thus, pre-surgery medication management isn’t just a precaution; it’s a critical safety measure.
Dr. Udgeath Dhir’s Golden Rule: “Timing is Everything”
According to Dr. Dhir, the timing of stopping medications varies depending on the drug class. Some medicines require discontinuation days before surgery, while others need to be adjusted only hours before.
Missing these timeframes can be risky — either leading to surgical complications or sudden worsening of the patient’s pre-existing heart condition.
That’s why Dr. Dhir and his team provide personalized pre-surgical counseling, giving each patient a tailor-made plan well ahead of the scheduled operation.
Blood Thinners: The First to Go
Antiplatelet drugs and anticoagulants are the main culprits behind excessive bleeding during surgery.
Common Blood Thinners That Need Stopping:
- Aspirin
- Clopidogrel (Plavix)
- Ticagrelor (Brilinta)
- Prasugrel (Effient)
- Warfarin (Coumadin)
- Dabigatran (Pradaxa)
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
Dr. Udgeath Dhir’s recommendation:
Most of these blood thinners need to be stopped 5–7 days before surgery to allow platelets and blood clotting factors to recover fully.
However, in patients at high risk of clot formation, alternative short-acting blood thinners (called bridging therapy) may be used temporarily under strict supervision.
Diabetes Medicines: Special Attention for Sugary Situations
Managing diabetes during surgery requires a delicate balance.
Many diabetic patients take oral hypoglycemics or insulin, both of which can dangerously lower blood sugar during surgery when patients are fasting.
Medicines That Need Adjusting:
- Metformin: Must be stopped 24–48 hours before surgery to prevent the rare but serious complication called lactic acidosis.
- SGLT2 inhibitors (like Dapagliflozin or Empagliflozin): These must be stopped at least 3 days before surgery to avoid dehydration and ketoacidosis.\
- Other oral medications and insulin: Usually adjusted or stopped the night before surgery as per individual patient need.
Important:
Blood sugar levels are continuously monitored during the surgical period, and insulin infusions may be used as needed during and after surgery.
Hypertension Drugs: Continue Some, Stop Others
High blood pressure control is essential for heart patients, but not all antihypertensive drugs are safe around the time of surgery.
Medications Under Review:
- ACE inhibitors (like Ramipril, Enalapril)
- ARBs (like Losartan, Valsartan)
These should typically be stopped the day before or the morning of surgery, as they can cause sudden blood pressure drops under anesthesia.
Beta-blockers (like Metoprolol, Bisoprolol), however, are usually continued because they protect the heart during the stress of surgery.
Calcium channel blockers (like Amlodipine) are often continued unless specifically contraindicated.
Anti-inflammatory Drugs: Silent Trouble Makers
Over-the-counter painkillers and anti-inflammatory drugs like:
- Ibuprofen
- Naproxen
- Diclofenac
can thin the blood and increase bleeding risks.
Dr. Dhir advises patients to stop these at least 7 days before surgery unless prescribed otherwise.
Safer alternatives for pain control are recommended if necessary.
Herbal and Natural Supplements: Not So Harmless
It’s not just prescription drugs that cause trouble.
Many natural supplements like:
- Ginkgo biloba
- Ginseng
- Fish oil
- Garlic pills
- Vitamin E
can thin the blood or interfere with anesthesia.
Dr. Dhir’s advice:
All herbal supplements must be stopped at least 1–2 weeks before surgery unless cleared by the surgical team.
Anti-Seizure and Psychiatric Medications: Cautious Continuation
Patients with conditions like epilepsy or psychiatric disorders must be extra cautious.
Stopping these medicines suddenly can be dangerous.
Thus:
- Most anti-seizure and psychiatric medicines are continued through surgery after adjustments.
- Sedatives, sleeping pills, and anti-anxiety medications may be stopped or adjusted to prevent interaction with anesthesia.
Thyroid Medications: Continue Under Monitoring
Patients with hypothyroidism or hyperthyroidism are advised to continue their thyroid medications right up to the day of surgery, usually with minimal changes.
Stable thyroid function is crucial for heart health during surgical stress.
Immunosuppressants and Chemotherapy: Handle With Extreme Caution
Patients with autoimmune diseases or cancer who are taking:
- Steroids
- Immunosuppressants
- Chemotherapy drugs
require specialist consultation.
Dr. Dhir’s approach:
Such drugs are adjusted carefully with input from oncologists or rheumatologists to avoid infection risks or surgical complications.
What Happens If You Accidentally Took Prohibited Medicine?
Mistakes can happen — and Dr. Dhir’s team is prepared.
If a patient unknowingly takes a medication that should have been stopped:
- The surgery may be delayed if safe to do so.
- Special precautions are taken intraoperatively to manage bleeding.
- Additional blood products or clotting agents are kept ready.
Honest communication with your surgical team is key — never hide such information.
The Emotional Side: Why Pre-Surgery Counseling Matters
Managing medications before surgery isn’t just a technical task — it plays a big role in mental preparation too.
When patients know they’ve done everything right medically:
- Anxiety levels drop
- Trust in the medical team rises
- Recovery rates improve
Dr. Udgeath Dhir strongly believes that informed patients heal faster and better.
Key Takeaways: Dr. Udgeath Dhir’s Top 5 Rules for Pre-Surgery Medication Safety
- Don’t assume: Always check with your surgical team about each medication you take.
- Don’t delay: Some drugs need stopping days or even weeks before surgery.
- Be honest: Inform your doctors about every pill — even supplements.
- Stay organized: Use a checklist or chart to track medication changes.
- Ask questions: No doubt is too small when it comes to your health.
Trust Your Heart with the Best: Book Your Consultation with Dr. Udgeath Dhir Today
Your heart deserves the best care — and so do you.
Dr. Udgeath Dhir, Director and Head of Cardiothoracic and Vascular Surgery at Fortis Memorial Research Institute, Gurgaon, offers world-class cardiac care based on precision, compassion, and cutting-edge techniques.
Whether you are preparing for a complex heart surgery, seeking a second opinion, or just looking to understand your heart health better — Dr. Dhir and his expert team are ready to guide you every step of the way.
Visit Dr Ugeath Dhir today to schedule your consultation.
Take control of your heart health — with expertise you can trust and care you can feel.
