David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco



Blood Thinners and Surgery

You are taking blood thinners and wonder if you should stop them for surgery.

You may be taking medications to thin your blood (actually, to inhibit clotting) because of medical conditions such as stroke, heart attack, preventing clots due to an irregular heart beat, or to prevent medical problems from occuring. Other medication you take may have the side effect of inhibiting clotting, such as aspirin or antiinflammatories. It is natural to ask, Should I stop taking my blood thinner medication?

There is no simple answer which will cover all cases. Surgery on the hand throughout the world is done with a tourniquet, primarily so that the surgeon can see the nerves, arteries, and other small structures in the hand. Bleeding during the surgery is not a problem. The main time when it can be a potential problem is after the surgery, when the tourniquet is removed.

In general, I can and do put pressure over the incision and the area of surgery, to allow the wound to stabilize, the blood clot to form, and to prevent bleeding. This controls bleeding in almost all cases in which you are taking blood thinners. There is still some risk of bleeding, however slight.

On the other hand, you are taking blood thinners for a reason, such as preventing a stroke or heart attack, and these are real and serious problems.

It has been my experience in the past that you are probably at greater risk if you stop the medication than if you continue it, so I have recommended for the past 20 years that patients continue their blood thinner medication. To date, none of my patients have had a bleeding problem. That is a good track record, but it is no guarantee for the future. You need to make your own decision about your healthcare options, the reasons you are taking your medication, the type of surgery you are having, and your experience with either taking or stopping taking your medication.

Talk to me about your concerns, and be sure to mention to me if you are taking blood thinners or medications such as aspirin that have the effect of thinning your blood.