Blood Thinners and Hand Surgery
If you regularly take a blood thinning medication to prevent strokes, heart attacks, deep vein thrombosis, pulmonary embolus or other types of blood clots, you may not need to cease this to have hand surgery.
Which Medications Are Blood Thinners?
Antiplatelet medications
- Aspirin (low dose). Brand names include Cartia®, Astrix®, Cardiprin® and Cardasa®, plus various pharmacy own brand low dose aspirin products.
- Clopidogrel. Brand names include Plavix®, Iscover® and Piax®, plus a number of generic clopidogrel products.
Anticoagulant medications
- Warfarin. Brand names include Coumadin® and Marevan®.
- Enoxaparin, an injectable blood thinner. Brand name Clexane®.
- Apixaban. Brand name Eliquis®, plus generic apixaban products.
- Rivaroxaban. Brand name Xarelto®, plus generic rivaroxaban products.
- Dabigatran. Brand name Pradaxa®, plus generic dabigatran products.
Apixaban, rivaroxaban and dabigatran are known as direct oral anticoagulants (DOACs). They are now among the most commonly prescribed blood thinning medications in Australia, and have in many cases replaced warfarin for conditions such as atrial fibrillation and prevention of blood clots.
Do I Need to Stop My Blood Thinning Medication Before Surgery?
Dr Tomlinson does not stop blood thinning medications for most operations. If there is a good reason for you to take this medication, it is usually appropriate to continue taking it around the time of your hand surgery.
The risks of stopping a blood thinner, such as stroke or heart attack, are generally greater than the risk of increased bruising or bleeding after hand surgery. That said, this is always a matter of weighing up the benefits and risks for your individual circumstances, and the right approach will depend on the medication you are taking, why you are taking it, and the type of surgery planned.
Can I Have Carpal Tunnel, Trigger Finger or Cyst Surgery While Taking Blood Thinners?
Many common hand surgery procedures, including carpal tunnel release, trigger finger (or thumb) release and digital mucous cyst excision carry a low risk of bleeding – and can also be performed under local anaesthetic if your cardiologist or neurologist recommends against sedation or a general anaesthetic because of recent heart attack, stroke or other medical condition.
In most cases, these procedures can go ahead while you continue taking your blood thinning medication, without needing to stop or interrupt it.
Recent Blood Clot, Heart Attack, Stroke or Cardiac Stent? You May Still Be Able to Have Hand Surgery
A recent diagnosis of deep vein thrombosis, pulmonary embolism, heart attack, stroke, or a recent cardiac stent does not automatically rule out having hand surgery, if surgery is indicated for your condition. In fact, these are often the reasons you are on a blood thinner in the first place, and stopping it to have surgery can carry its own serious risks, including a higher chance of a further stroke, heart attack or pulmonary embolism.
For suitable, low bleeding risk procedures, it is often possible to proceed with your blood thinning medication unchanged. Every patient is assessed individually. Dr Tomlinson will discuss your medical history, current medications and the surgery planned with you, and liaise with your cardiologist, neurologist or GP where needed, before deciding on the right approach for you.
What You Need to Do
If you are taking a blood thinning medication of any kind, we need to discuss this before your surgery so we can determine the right approach for you.
Please do not stop your medication without first obtaining medical advice.