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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Cardiology, Cardiovascular Surgery

Medicines, Herbs and Vitamins which Affect Bleeding (6404)

Medicines, Herbs and Vitamins which Affect Bleeding (6404) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Cardiology, Cardiovascular Surgery

6404


Medicines, Herbs and Vitamins Which Affect Bleeding

Many medicines, herbs, vitamins and dietary supplements may increase bleeding during and after a procedure
(test or surgery). Below is a list of the common agents that may cause bleeding. This is not a complete list.
You should tell your doctor all of the medicines, herbs, vitamins or supplements that you are taking prior to any
procedure.

Anticoagulants
Stop taking your anticoagulant (blood thinner) as directed. Do not restart it until told to do so by your doctor.
Contact your doctor’s office if you are not sure whether a medicine is safe to take.
Drug Name Hold Plan
Warfarin (Coumadin®) INR between 2-3: stop warfarin 5 days before surgery or procedure
INR between 3 – 4.5: stop warfarin 6 days before surgery or procedure
Dalteparin (Fragmin®)
Enoxaparin (Lovenox®)
Therapeutic dose: stop 24 hours before surgery or procedure
Prophylactic dose: stop 12 hours before surgery or procedure

Drug Name Standard Bleeding Risk High Bleeding Risk
Apixaban (Eliquis®) Stop 1 day before surgery or procedure Stop 2 days before surgery or procedure
Dabigatran (Pradaxa®) Stop 1-2 days before surgery or procedure Stop 2-4 days before surgery or procedure
Rivaroxaban (Xarelto®) Stop 1 day before surgery or procedure Stop 2 days before surgery or procedure
Edoxaban (Savasya) Stop 1 day before surgery or procedure Stop 2 days before surgery or procedure
* Patients with impaired kidney function will need to stop these agents 3-5 days prior to procedure

Antiplatelets
Drug Name Hold Plan
Aspirin (any brand, all doses) Your surgeon’s office will determine when to stop taking this
medicine before your surgery.
Cilostazol (Pletal®) Stop 1-2 days before surgery or procedure
Clopidogrel (Plavix®) Stop 5days before surgery Your surgeon may adjust this if
appropriate.
Dipyridamole (Persantine®) Stop 1-2 days before surgery or procedure
Dipyridamole/Aspirin (Aggrenox®) Stop 7-10 days before surgery or procedure
Prasugrel (Effient®) Stop 5-7 days before surgery or procedure
Ticagrelor (Brillinta®) Stop 5days before surgery. Your surgeon may adjust this if
appropriate.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Stop taking these 7 days before and 7 days after your surgery or procedure
Celecoxib (Celebrex®) Ibuprofen (Motrin®Advil® Nuprin®) Nabumeton (Relafen®)
Diclofenac (Voltaren® Cataflam®) Indomethacin (Indocin®) Naproxen (Naprosyn®Aleve®)
Diflunisal (Dolobid®) Ketoprofen (Orudis®, Actron®) Oxaprozin (Daypro®)
Etodolac (Lodine®) Ketorlac (Toradol®) Piroxicam (Feldene®)
Fenoprofen (Nalfon®) Meloxican (Mobic®) Sulindac (Clinoril®)










Herbs, Vitamins, Dietary Supplements
Stop taking these 10-14 days before and 7 days after your surgery or procedure

Dong Quai Ginger Omega-3-fatty acid (high dose)
Feverfew Ginkgo Biloba Vitamin E (high dose)
Garlic (high dose) Ginseng


To Our Patient’s Doctor:
For more information on anti-thrombotic medicines in the periprocedural setting, please see our UW Health
Guidelines on Periprocedural Anticoagulation. This guideline can be accessed at
www.uwhealth.org/anticoagulation.




































Your health care team may have given you this information as part of your care. If so, please use it and call if you have any
questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice.
This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you
should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call
911. Copyright © 3/2017 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department
of Nursing. HF#6404