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COCP Perioperative Management — FRCA Final MCQ

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ModeratePreoperative AssessmentCOCP Perioperative ManagementFRCA Final

A 40-year-old woman (ASA I) with migraine with aura is listed for laparoscopic cholecystectomy. She takes the combined oral contraceptive pill (COCP). What is the recommended perioperative management of her COCP regarding venous thromboembolism risk?

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Correct answer: A — Continue the COCP – no increased VTE risk

Current NICE NG89 guidance and RCOG recommendations have shifted away from routinely stopping the COCP before surgery. The VTE risk from COCP is low and is now managed with pharmacological thromboprophylaxis (LMWH) and mechanical measures (TED stockings, IPC devices) rather than drug cessation. If the COCP is stopped, alternative contraception and the risk of unplanned pregnancy must be addressed. For major surgery with prolonged immobility, individual risk assessment is warranted. Her migraine with aura is a separate cardiovascular consideration for COCP use generally.

Reference: NICE – 2018 – NG89 VTE risk reduction; RCOG – 2015 – VTE in pregnancy and puerperium