Table 4.

Framework for preoperative assessment of patients with a prior history of stroke or TIA

History of stroke and/or TIA
  • Date it occurred

  • Type of stroke (infarction or haemorrhage)

  • Secondary prevention medications, eg antiplatelets, anticoagulants, anti-hypertensives, statins

  • Residual deficit from the stroke

  • Previous stroke-related investigations, eg brain imaging carotid Doppler ultrasound, ECG, echocardiography

Decide upon the timing of surgery in relation to the stroke/TIADelay elective surgery for 3 months unless mortality benefit from urgent surgical treatment likely to outweigh stroke risk
Formulate a perioperative management plan for patients taking antiplatelet agents and/or anticoagulationPerform a comprehensive individual assessment of thrombotic risk of stroke versus bleeding risk of surgery
Identify potential perioperative complications
Communicate the individualised management plan to all healthcare professionals involved in the surgical pathway in agreement with the patient
  • ECG = electrocardiogram; TIA = transient ischaemic attack.