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Blood Thinners and Surgery: What's Your Risk of Bleeding or Clots?
Published: Sep 22, 2024
If you take blood thinners and need surgery, you face two competing risks: bleeding during the procedure or developing blood clots if you stop your medication. How can you and your doctor navigate this balancing act?
Assessing Bleeding Risk
Your bleeding risk depends mainly on the type of surgery you're having. Major operations like heart surgery or brain surgery carry a high bleeding risk. Smaller procedures like a skin biopsy have lower risk. Your doctor will also consider factors like your age, kidney function, and other medications you take.
Evaluating Clotting Risk
Your risk of blood clots when stopping blood thinners depends on why you take them. Patients with mechanical heart valves or recent strokes have the highest risk. Those taking blood thinners for atrial fibrillation have varying risks based on age and other health conditions. A scoring system called CHA2DS2-VASc helps estimate this risk.
Balancing the Risks
For most patients, the risk of dangerous bleeding outweighs the short-term risk of blood clots when stopping blood thinners briefly. However, high-risk patients may need special measures like 'bridging' therapy with injectable blood thinners. Your doctor will create a personalized plan based on your specific risks.
Minimizing Your Risks
Careful timing of when you stop and restart your blood thinner is crucial. Newer blood thinners can often be stopped closer to surgery than older ones like warfarin. After surgery, you may receive smaller doses of blood thinners until it's safe to restart your full dose. Following your doctor's instructions precisely helps minimize risks.
Frequently Asked Questions
It varies, but bleeding risk often outweighs clotting risk.
For some minor procedures, yes, but most require stopping.
Usually 1-5 days before surgery and 1-3 days after.
Special reversal agents may be used to reduce bleeding risk.
This theoretical risk hasn't been proven in studies.
The Bottom Line
Understanding and managing your personal risks is key to safely undergoing surgery while on blood thinners.
References
- Spyropoulos AC et al. Blood. 2012;120(15):2954-2962.
- Douketis JD et al. Chest. 2012;141(2):e326S-e350S.
- Tafur A et al. Heart. 2018;104(17):1461-1467.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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