.
It is important that you advise your surgeon if you are taking blood thinners, as a decision will need to be made as to whether or not to stop them prior to your endoscopy procedure or operation.
This decision needs to be individualised, based on your risks, and the procedure you are having.
HIGH RISK PATIENTS
If you have a mechanical heart valve or have had a recent stent inserted (e.g. coronary or vascular stent), in the past 12 months, it may not be safe to stop your blood thinner, and a decision will need to be made about whether or not it is safe to proceed with surgery. Sometimes involvement of your cardiologist or vascular surgeon will be required.
LOW RISK PATIENTS
Low risk patients include those who are on blood thinners for prevention with no previous history of clotting or cardiac event. The low risk category also includes those taking blood thinners because of a history of clotting or cardiac event many years ago with no recent symptoms or events.
BLOOD THINNER TYPES
The types of blood thinners used, broadly speaking, are categorised into those that are anti-platelet agents, the most common one being aspirin, and those that are anticoagulant agents. Anticoagulant agents can be both oral, the most commonly is warfarin, or come as an injection.
A complete list of blood thinners is presented below.
ANTI PLATELET AGENTS
ORAL ANTI-COAGULANTS
- warfarin (brand names Coumadin, Marevan)
- dabigatran (Pradaxa)
- apixaban (Eliquis)
- rivaroxaban (Xarelto)
- fondaparinux (Arixtra)
INJECTABLE ANTI-COAGULANTS
STOPPING BLOOD THINNERS – LOW RISK PATIENTS
If you are low risk (no recent coronary stent, clot or cardiac event in last 12 months) you may be advised to stop your anti-platelet agent (7 days prior to your surger) or your anticoagulant agent (3 days prior to your surgery), and restart it after your surgery. Please have this conversation with your treating surgeon.
STOPPING BLOOD THINNERS – HIGH RISK PATIENTS
In high risk patients sometimes dual anti-platelets are required. A common combination is aspirin and clopidogrel. This is particularly so if recent cardiac stenting has occurred in the last 12 months. In this situation your cardiologist may be happy for you to stop one of your dual anti-platelet agents 7 days prior to your procedure.
High risk patients on oral anticoagulation include those with a mechanical heart valve, or recent clotting event. In high risk patients, sometimes oral anticoagulants are stopped four days before surgery, and a short-acting injectable anticoagulant such as enoxaparin (Clexane) is injected subcutaneously daily two to three days prior to surgery. This reduces the risk of clotting during your surgery, but because enoxaparin (Clexane) is short acting, it also wears off completely by the time of your surgery thereby reducing the risk of bleeding during and after surgery. If you are considered high risk, thhis may be an option for you so please have this conversation with your treating surgeon.
LOW RISK PROCEDURES
Low risk procedure such as gastroscopy and colonoscopy where no biopsies are taken represent very little bleeding risk. Occasionally it is appropriate for patients at high risk of clotting to remain on their blood thinner prior and during their low risk procedure. Again, this is a decision best made with your treating cardiologist‘s or vascular surgeon’s input.