Blood Thinners Perioperative: What You Need to Know Before Surgery

When you're on blood thinners, medications that prevent dangerous clots by slowing down your blood’s ability to form them. Also known as anticoagulants, they help people with atrial fibrillation, deep vein thrombosis, or artificial heart valves stay safe—but they become tricky when surgery is involved. Stopping them too early raises your risk of a stroke or clot. Stopping them too late? You could bleed out during or after the procedure. This isn’t guesswork—it’s a careful balancing act that needs timing, planning, and clear communication with your care team.

That’s where bridging therapy, a temporary switch to a faster-acting anticoagulant like heparin while you pause your regular blood thinner comes in. But here’s the thing: bridging isn’t always needed anymore. For many people taking newer drugs like DOACs, direct oral anticoagulants such as apixaban, rivaroxaban, or dabigatran, stopping the medication for a few days before surgery and restarting it right after is enough. No heparin shots required. But if you’re on warfarin, an older blood thinner that takes days to build up or wear off, your doctor might still recommend bridging—especially if you’re at high risk for clots. The decision depends on your condition, the type of surgery, and how well your blood has been controlled.

It’s not just about the drugs. It’s about timing. A minor dental procedure? You might not need to stop anything. A knee replacement or colon surgery? That’s different. Your surgeon and pharmacist need to know exactly what you’re taking, when you last took it, and why. Even something as simple as stopping aspirin or fish oil a week before can make a difference. And don’t forget: some supplements and over-the-counter painkillers act like blood thinners too. Ibuprofen, naproxen, garlic, ginkgo—these can pile up the risk.

What you’ll find below are real, practical guides written for people who are either preparing for surgery or managing blood thinners after one. You’ll see how others handled switching from warfarin to DOACs before a hip repair. You’ll learn why some patients bleed more than others even when their numbers look fine. You’ll get tips on tracking doses, recognizing signs of trouble, and talking to your doctor without sounding confused. No fluff. No jargon. Just what works—based on real cases, real data, and real questions from people who’ve been there.