Anticoagulants Before Surgery: What You Need to Know

When you're on anticoagulants before surgery, medications that prevent dangerous blood clots by thinning your blood. Also known as blood thinners, they're essential for people with atrial fibrillation, deep vein thrombosis, or artificial heart valves. But when surgery comes up, these same drugs can turn into a serious risk—too much bleeding during the procedure could be life-threatening. That’s why stopping or adjusting them isn’t a simple decision. It’s a careful balancing act between preventing clots and avoiding excessive bleeding.

Not all blood thinners are the same. Warfarin, an older anticoagulant that requires regular blood tests to monitor its effect, often needs to be stopped days before surgery and sometimes replaced with a short-acting injectable like heparin. On the other hand, DOACs, newer drugs like apixaban or rivaroxaban that work faster and wear off quicker, usually just need to be held for 24 to 72 hours depending on your kidney function and the type of surgery. The idea of bridging therapy, temporarily switching from a long-acting anticoagulant to a short-acting one before surgery used to be common—but now, research shows it’s often unnecessary and increases bleeding risk without reducing clots.

What’s your surgery? A simple dental extraction? A knee replacement? A heart procedure? Each one changes the game. Minor procedures might not need you to stop anything at all. Major surgeries? That’s where timing matters most. Your doctor will look at your personal clotting risk—did you have a recent stroke or pulmonary embolism?—and match the plan to your actual danger level, not just the drug name on your bottle.

You’ll also need to know what to avoid. Some supplements like fish oil, garlic, or ginkgo can thin your blood too. Even over-the-counter painkillers like ibuprofen can add to the risk. And don’t forget your timing: if you’re supposed to skip your morning pill, don’t take it after breakfast thinking it’ll still be safe. These drugs work fast, and your body doesn’t wait for convenience.

What you’ll find in the posts below isn’t just theory. It’s real guidance from people who’ve been through it—how to talk to your surgeon, what questions to ask your pharmacist, how to track your meds without mixing them up, and why some people need to switch from warfarin to a DOAC before surgery while others don’t. There’s no one-size-fits-all rule here. But with the right info, you can walk into your pre-op appointment knowing exactly what to expect—and what to demand.