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Is it safe to stop blood thinners before surgery?

Doctors typically require patients to stop taking blood thinners at least 24 hours before surgery
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By | Jun. 9, 2024 Medically reviewed by Youssef Ghobrial, MD
An Rx pill bottle inside of a heart drawing: Is it safe to stop blood thinners before surgery?

Key takeaways

  • Blood thinners are important in pre-and post-surgical care since blood clots are more common after surgery. 

  • Patients must stop taking blood thinners around 2–10 days before surgery, depending on the drug and procedure. 

  • Doctors often begin administering blood thinners again 24–72 hours after surgery, depending on the medication. 

In this article:

Blood thinners are effective in reducing the risk of clots and heart attacks, but their use in a pre-surgery regimen is complicated. While anticoagulants like Warfarin, Eliquis, Xarelto, or aspirin might be necessary for people with certain heart conditions, surgeons might ask you to stop taking them before surgery. Why? We’ve got the answers right here. 

Should you stop taking blood thinners before surgery?

Surgery comes with an inherent risk of blood loss, and blood thinners can make it more difficult to stop bleeding. So the question becomes: Should you stop taking blood thinners before surgery? In most cases, the answer is yes. 

But it’s not as black and white as it might seem. “The decision to hold blood thinners involves a delicate risk-benefit analysis,” says Dr. Taher Saifullah, founder of the Los Angeles-based Spine and Pain Institute. “While excessive bleeding during surgery is a concern, we also need to consider the patient’s risk of blood clots. Stopping blood thinners can cause an increased risk of a deep vein thrombosis (DVT) in the legs or a pulmonary embolism, a blood clot that travels to the lungs.” 

While they might sometimes be a crucial part of the preparation, surgical procedure, and recovery process, doctors must be careful about preoperative blood thinner dosage. Per Dr. Saifullah, “In complex cases, or for patients with specific medical conditions, consulting a hematologist is advisable to tailor the management of blood thinners before surgery.” Doctors typically require patients to stop taking blood thinners at least 24 hours before surgery, and the exact timeline depends on the medication and procedure being performed. Per the National Blood Clot Alliance, here’s when you’ll typically need to stop taking certain common anticoagulant drugs:

  • Warfarin: About 5 days before
  • Eliquis, edoxaban, or Xarelto: 2–3 days before (depending on kidney health)
  • Dabigatran: 3–5 days before (depending on kidney health)
  • Aspirin: 7–10 days before

Failing to cease blood thinner treatment before surgery can increase the risk of excessive blood loss since the blood won’t be able to coagulate during the procedure. This risk, however, can also depend on the specific operation. “If you are having a minor oral surgery, your surgeon may inform you that you don’t need to avoid blood thinners at all,” says Dr. Jerry Friedman, North Jersey Oral & Maxillofacial Surgery. “But if you are having some kind of major bodily surgery, your surgeon may inform you that you need to stop taking blood thinners several weeks before the surgery.”

Without these medications, some doctors may prescribe bridge therapy. This involves administering a short-acting anticoagulant, such as heparin or low-molecular-weight heparin (LMWH), in the days before surgery.

What if you need surgery while on blood thinners?

Sometimes, surgery is unavoidable, and if you’re already taking blood thinners, you may just need to wait for them to leave your system. That time frame varies based on the drug. For example, the Xarelto website says it will leave the body in around 24 hours, while aspirin can take up to 10 days. 

But don’t go based solely on information you find online. Rely on your physician’s medical advice. “When you have surgery scheduled, your doctor should discuss blood thinners with you ahead of time so that you know what you can and cannot take and when,” says Dr. Friedman.

When is it safe to take blood thinners after surgery?

A CDC study reported that approximately one out of every 100 patients developed a blood clot after surgery. That’s why blood thinners are an important part of post-op recovery. However, the specific timeline varies based on the patient and type of surgery. “The surgeon will assess the surgical site for signs of ongoing bleeding before restarting blood thinners,” says Dr. Saifullah. They “may use alternative pain management methods initially to avoid interfering with clotting while the surgical wound heals.”

According to a 2017 literature review, as long as nothing happened during surgery that would increase the risk of bleeding, here’s when patients can resume taking blood thinners: 

  • Warfarin: 12–24 hours after surgery
  • Rivaroxaban, apixaban, and dabigatran: 48–72 hours after surgery
  • Aspirin: 24 hours after surgery
  • Clopidogrel: 24 hours after surgery

The NIH says here’s how long patients need to wait before resuming bridge treatment:

  • LMWH or heparin for minor surgeries: 24 hours after surgery 
  • LMWH or heparin for major surgeries: 48–72 hours after surgery  

Doctors don’t prescribe blood thinners after all surgeries. In some cases, however, the doctor may require you to take them for up to 35 days after the operation. 

Blood thinners may also interact with other drugs. These interactions include antifungals like fluconazole, heart medications like amiodarone, acetaminophen, ibuprofen, seizure medicines, and many different antibiotics. Let your healthcare provider know if you take any of these medications before surgery.