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Little evidence is available for perioperative med management. The information in this database is largely derived from expert opinion. Available evidence is listed within the Details report. Many institutions have their own policies regarding perioperative management of many medications; clinicians should reference those. Herbal medications and supplements are not included in the database. Since virtually no evidence supports their use even long-term, all should be stopped at least 7 days before surgery to prevent potential drug interactions and complications. Vitamins/supplements prescribed for a specific purpose (e.g., vitamin D and calcium for osteoporosis, vitamin B12 for B12 deficiency) should be continued, but all others (especially any including vitamins A and E [theoretical increased bleeding risk]) should be stopped 7 days before surgery. Recent data from OPERA trial suggests fish oil may be safe to continue (Akintoye et al).

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