Aspirin bottle

Aspirin should be avoided at surgery time

Bleeding and bruising are a part of any eyelid surgery. Knowing what blood thinners to stop and when to stop them is important to minimize bleeding complications with eyelid surgery.  Most people are started on blood thinners by their primary care doctor or their cardiologist.  These medicines reduce the risk of blood clotting inside of vessels, which can cause complications such as heart attack, stroke and pulmonary embolus.  It is important that you speak with your doctor about the safety of stopping blood thinners temporarily for surgery.

Common Blood Thinners

While there are hundreds of medications that affect how well your blood clots, a few are very commonly used. These fall into a few categories.

Aspirin and aspirin containing medicines

Aspirin, in my experience, is one of the most dangerous blood thinners when taken around surgery time.  Not only does it make stopping bleeding during surgery very difficult, it’s effects can last weeks from when you stop taking it.  Also, many of our patients don’t even mention aspirin when asked about the medications they are taking. They think it is so trivial, almost like a vitamin, that they don’t have to mention it.  Aspirin causes platelets to not stick together. Once taken, any platelets in your blood will be permanently affected. Thankfully, your bone marrow is always making platelets, but it takes 10-12 days to replace all of them. Thus, you need to be off aspirin for 10-12 days to completely remove its effect.  Watch out for medications that contain aspirin mixed with other drugs, such as Alka Seltzer and Excedrin.

NSAIDS

Many other common pain medications cause thinning of the blood.  Ibuprofen (Motrin, Advil) and naproxen (Aleve) are the most commonly used.  They are slightly less potent than aspirin with respect to thinning the blood, but work by a similar mechanism and need to be stopped for 10-12 days as well.  Like aspirin, NSAIDs can be found mixed with other medications.

Prescription Anticoagulants

Coumadin (Warfarin), Heparin and Plavix have been the staple prescription blood thinners for many years, but lots of new medications have come on the market in the past few years. Xarelto, Eliquis and Pradaxa are newer anticoagulants that also can cause serious bleeding complications during and after surgery.  If you are taking these medications, chances are you have a more serious condition and should always speak with your doctor prior to altering your dosage or stopping it.

Vitamins and Herbal Remedies

Many vitamins over-the-counter remedies, such as Vitamin E and fish oil, thin the blood and can cause surgical complications.  Some of these take up to 3 weeks to lose their effects.  Be sure and share all your medications with your doctor, including over-the-counter medications you may not think are important.

See this article for a list of medications to avoid at surgery, and speak with your surgeon and primary care doctor prior to stopping any medication.

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