A 2022 perioperative medication management clinical practice guideline from the University of Wisconsin Health, developed to standardize perioperative medication practices and reduce complications in patients undergoing procedures requiring anesthesia, recommends that perioperative management of pentoxifylline be coordinated with the surgeon and prescribing provider (strong recommendation, low quality of evidence). The guideline defines “hold” as a temporary interruption of therapy and emphasizes that perioperative medication decisions should involve assessment of risks and benefits and collaboration among the anesthesiologist, surgeon, and prescribing clinician. Within this framework, no specific recommendation is provided regarding continuation, discontinuation, or timing of pentoxifylline prior to surgery. [1]

A 2024 UK Clinical Pharmacy Association Handbook of Perioperative Medicines review states that pentoxifylline (Trental) should be continued during both elective and emergency surgery, with no recommendation to routinely hold the medication preoperatively. The guidance notes that omission may result in loss of symptom control, while continuation carries a potential, though not definitively established, increased risk of bleeding. Postoperatively, pentoxifylline should be restarted once enteral intake is resumed, with monitoring of renal function and consideration of dose adjustment in the presence of postoperative renal impairment. The document further highlights that rare bleeding events have been reported, particularly in patients with additional risk factors or concomitant therapies, but a causal relationship has not been established. [2]

Institution-specific perioperative medication protocols from Oklahoma Spine Hospital, Virginia Interventional Pain & Spine Center, and Waukee Surgery Center consistently classify pentoxifylline (Trental) as a blood thinner/anticoagulant-antiplatelet agent and recommend holding it prior to procedures or surgery, with reported discontinuation intervals ranging from 5 to at least 7 days: Oklahoma Spine Hospital recommends discontinuation 7 days prior to surgery with a corresponding 7-day washout period; Virginia Interventional Pain & Spine Center recommends holding pentoxifylline for at least 7 days prior to procedures, including spinal injections, and specifies that anticoagulants should not be discontinued without approval and documentation from the prescribing provider; and Waukee Surgery Center provides a general recommendation to discontinue pentoxifylline 5 days before surgery, while also advising that anticoagulant management should ultimately follow instructions from the prescribing physician or surgeon; however, none of these documents provide cited references or supporting evidence within the protocols themselves. [3], [4], [5]