By thinning the blood, there is a higher risk for bleeding. During surgery this can be a problem. But that is only half the problem. The opposite is also true. If you stop blood thinners before surgery to prevent bleeding you can get a clot.
All kinds of blood thinners (antiplatelets or anticoagulants) can be a problem during surgery. Depending on your risk profile, the severity of the underlying condition you are receiving blood thinners for and the type of surgery you will undergo will guide your doctors’ decision towards one of the following solutions:
- Stop the blood thinners before surgery and start them after surgery has passed. This option can be used if the surgery is high risk for bleeding and the need for a blood thinner is not very strong.
- Change the blood thinner to a different kind for the time before and sometimes after surgery. Some blood thinners are cleared quickly by the body. Heparin is an example. This is a good solution for people who cannot stop blood thinners for too long. There are several kinds of alternatives. Some require injections and some require being in the hospital for intravenous treatment.
- Changing the type of surgery. Some surgical procedures are riskier than others. Choosing a low risk procedure can make sense sometimes.
- Not having surgery performed. This may sound harsh, but sometimes the risk for clots is so great that surgery needs to be reconsidered. Sometimes surgery is just postponed and sometimes it is cancelled altogether.
- Have the surgery done without stopping the blood thinners. This is true for vascular and cardiac procedures where blood clotting is a major concern.
- Placement of a vena cava filter. This is recommended for patients who are on blood thinners for a venous thrombosis or pulmonary embolism and will need to stop them for the surgical procedure. The Inferior vena cava is the large vein which is formed when the two large leg veins (iliac veins) merge in the pelvis. The vena cava transfers the blood back to the heart. The vena cava filter can catch blood clots that move from the leg veins to the lung.