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Perioperative & ERAS Pharmacotherapy

Systemic pharmacotherapy surrounding the perioperative window: VTE prophylaxis, anticoagulation reversal, bowel preparation, postoperative bowel / ileus management, and systemic corticosteroids. These pages are the drug-class hubs (agents, doses, FDA labels, evidence ceilings); the Perioperative Care section provides the bedside workflow companions (Caprini in urology, bridging, stress dosing, etc.). Each pair has explicit cross-reference boxes to keep facts in one place.

Recent shifts include the andexanet alfa US market withdrawal (4F-PCC or activated PCC are primary reversal options for patients taking factor Xa inhibitors when rapid reversal is needed for life-threatening or critical-organ bleeding or urgent surgery[1][2]), the 2026 EAU strong recommendation against preoperative bowel preparation before radical cystectomy[3] (24 of 25 cystectomy ERAS protocols reviewed in 2020 omitted oral preparation[4]; overlapping 2019–2020 NSQIP analyses associated oral antibiotics with less sepsis after continent diversion in a 2023 meeting abstract[5] and bowel regimens overall with shorter neobladder stay but oral antibiotics with longer ileal-conduit stay in a 2025 article[6]; a 2026 NSQIP cohort associated oral antibiotics with more postoperative ileus after cystectomy[7]), and mixed alvimopan findings within cystectomy ERAS pathways (a 2021 single-center retrospective cohort associated alvimopan with shorter stay[8]; a 2026 randomized meeting abstract of 132 patients found similar composite gastrointestinal recovery and median stay with alvimopan and placebo[9]).

  • VTE ProphylaxisRisk assessment and drug choice for preventing blood clots after urologic and pelvic surgery.
  • Anticoagulation ReversalReversing warfarin, heparin and the newer oral anticoagulants before or during surgery.
  • Bowel PreparationWhen mechanical bowel preparation and oral antibiotics are worthwhile before diversion and bowel surgery.
  • Postop Bowel & Ileus ManagementPreventing and treating postoperative ileus and constipation after diversion, augmentation and channel surgery.
  • CorticosteroidsWhere corticosteroids are used in urology, from nausea prevention to Hunner lesions, with links to stress dosing.

References​

1. US Food and Drug Administration. Update on the Safety of Andexxa by AstraZeneca: FDA Safety Communication. December 18, 2025. FDA

2. Kumbhani DJ, Armbruster AL, Cheng RK, et al. "Direct Oral Anticoagulants in Primary and Secondary Prevention of Thrombotic Events: 2026 ACC Scientific Statement: A Report of the American College of Cardiology." J Am Coll Cardiol. 2026;88(11):1255-1283. doi:10.1016/j.jacc.2026.05.033

3. European Association of Urology. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Disease Management. 2026. EAU guideline

4. Wessels F, Lenhart M, Kowalewski KF, et al. "Early recovery after surgery for radical cystectomy: comprehensive assessment and meta-analysis of existing protocols." World J Urol. 2020;38(12):3139–3153. doi:10.1007/s00345-020-03133-y

5. Simhal R, Wang K, Poluch M, et al. "Preoperative oral antibiotic bowel preparation regimens in radical cystectomies with continent diversion." J Clin Oncol. 2023;41(16 Suppl):e16610. doi:10.1200/JCO.2023.41.16_suppl.e16610

6. Simhal RK, McPartland C, Wang KR, et al. "Bowel regimens before radical cystectomy: an analysis of a modern cohort." Int J Urol. 2025;32(4):402–408. doi:10.1111/iju.15668

7. Manivasagam SS, Clark JY, Raman JD. "Unintended consequences of antibiotic practices: the relationship between bowel preparation, prolonged prophylaxis, and ileus after radical cystectomy." Can J Urol. 2026;33(4):865–871. doi:10.32604/cju.2026.078196

8. Hanna P, Regmi S, Kalapara A, et al. "Alvimopan as part of the enhanced recovery after surgery protocol following radical cystectomy is associated with decreased hospital stay." Int J Urol. 2021;28(6):696–701. doi:10.1111/iju.14546

9. Yim K, Lukas V, Liu X, et al. "PD19-03 Alvimopan in patients undergoing radical cystectomy and urinary diversion on a standardized enhanced recovery after surgery protocol: a randomized, double-blind, placebo-controlled trial." J Urol. 2026;215(5S):e1098. doi:10.1097/01.JU.0001191604.52386.88.03