Exam Question of the Day
A 47 y/o G3P2 is scheduled for a total hip replacement. She is on a monophasic oral contraceptive for anovulatory cycles. When should you stop them?
A. 2 weeks
B. 4 weeks
c. 6 weeks
D. 8 Weeks
E. 10 weeks
Source: Pearls of Exxcellence.org Nov. 2008
Peri-operative deep vein thrombosis (DVT) is detected about twice as often in women who use oral contraceptives than in those who do not in the few studies that have performed such comparisons. For this reason it has been recommended that hormones be discontinued prior to surgical procedures that will require immobilization. In a menopausal women, discontinuation of hormones would be relatively simple clinical decision, since the potential for pregnancy no longer exists and the odder age of women at menopause puts them at overall higher risk for DVT. A waiting period of 6 weeks is optimal, since it allows liver induced clotting factors to normalize. In the absence of luxury of such a waiting period, hormones should be discontinued as soon as the clinician is aware of the need for the surgical intervention.