A 59-year-old man is planning to undergo a coronary aery bypass. He has osteoahritis and consumes nonsteroidal anti-inflammatory drugs (NSAIDs) for the pain. Which of the following is the most appropriate treatment prior to surgery to minimize his risk of bleeding from his NSAID use?

**Core Concept**
The management of patients on NSAIDs undergoing surgery is crucial due to their antiplatelet effects, which increase the risk of bleeding. In this scenario, the patient's osteoarthritis necessitates NSAID use, and the risk of bleeding during coronary artery bypass grafting must be mitigated.

**Why the Correct Answer is Right**
Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the activation of plasminogen to plasmin, thereby reducing fibrinolysis and minimizing bleeding risk. Its effectiveness in reducing perioperative blood loss and transfusion requirements has been demonstrated in various surgical settings, including cardiac surgery. TXA can be administered orally or intravenously, and its use is recommended for patients on anticoagulant or antiplatelet therapy, such as NSAIDs.

**Why Each Wrong Option is Incorrect**
**Option A:** Vitamin K is used to reverse warfarin-induced anticoagulation, but it is not effective against the antiplatelet effects of NSAIDs.
**Option B:** Desmopressin is used to treat bleeding disorders like hemophilia A and von Willebrand disease, but it is not indicated for NSAID-induced bleeding risk.
**Option C:** Platelet transfusions may be necessary in cases of severe bleeding, but they do not address the underlying issue of NSAID-induced platelet dysfunction.

**Clinical Pearl / High-Yield Fact**
When managing patients on NSAIDs for surgery, consider using antifibrinolytic agents like tranexamic acid to minimize bleeding risk, and always assess the patient's coagulation profile before surgery.

**Correct Answer:** C.

✓ Correct Answer: D. Stop the NSAIDs 3 to 4 days prior to surgery.