A 73 yo CM with PMH of Crohn’s diease, HTN, and Afib takes mesalamine (Asacol) to control his diarrhea. He is seen by an internal medicine physician for preoperative evaluation 1 week prior to surgery for total knee replacement forOA.
Should we stop mesalamine to avoid bleeding complications during surgery?
No.
Mesalamine (Asacol) does not affect platelets the same way aspirin and other NSAIDs do.
According to one study, there was not effect on platelet aggregation during normal treatment with 5-aminosalicylic acid when given at a dose of 1.5 gm po qd or even after IV administration. All in vivo and in vitro tests were negative for inhibition of platelet aggregation in contrast to the inhibition seen with aspirin (acetylsalicylic acid). Authors concluded that treatment with mesalazine does not constitute a hazard to patients with IBD in regard
This is one of the series of perioperative questions I will answer on this web site. They will be submitted as clinical vignettes to the Cleveland Clinic Annual Perioperative Summit next year. This year’s summit is in September and several of the perioperative cases in nephrology will be presented as posters and published as abstracts in the Cleveland Clinic Journal of Medicine.
References:
Lack of effect of 5-aminosalicylic acid on platelet aggregation and fibrinolytic activity in vivo and in vitro. Winther K, Bondesen S, Hansen SH, Hvidberg EF. Eur J Clin Pharmacol. 1987;33(4):419-22.
Image source: Wikipedia, Free Documentation License.
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