Should I stop my blood thinners before skin cancer surgery?

. March 31, 2019.
ISS_12275_01147

A question Dr. Molenda at Bravia Dermatology often gets from patients is whether they should stop their blood thinner before surgery. The answer is almost always no — do no stop your prescribed blood thinner. This is especially important for patients with a history of heart attack, stroke, or blood clots.

While being on blood thinners does significantly increase the risk of bleeding, bruising, and hematomas (collection of blood under the skin after surgery), the BENEFITS of these medications greatly OUTWEIGH THE RISKS. Specifically, bleeding after skin surgery is inconvenient and sometimes a bit messy, but it is not nearly as inconvenient as a heart attack, stroke, or blood clot.

The risk of clots wreaking havoc is a real one… no matter what age the patient is. In fact, even very young people can get blood clots.

Blood thinners (anti-coagulants) work in a variety of ways, and are available by prescription or over-the-counter. Prescription blood thinners should never be stopped for skin surgery without explicit directions from your physician. Dr. Molenda suggests that patients on Coumadin (Warfarin) have their INR levels checked prior to surgery and make sure the level is under 3.0.

Examples of prescription blood thinners include:
(DO NOT STOP PRIOR TO SKIN SURGERY)
Clopidogrel (Plavix) – Oral Capsure
Warfarin (Coumadin, Jantoven) – Oral Tablets
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Heparin
Bivalirudin (Angiomax) – Powder For Injection
Argatroban (Acova) – Injection
Dabigatran (Pradaxa) – Oral Capsule
Apixaban (Eliquis) – Oral Tablets
Fondaparinux (Arixtra) – Injection
Rivaroxaban (Xarelto) – Oral Tablets
Edoxaban (Savaysa) – Oral Coated Tablets

Examples of Over-The-Counter Blood thinners include aspirin, fish oil, garlic supplements, gingko supplements, and vitamin E. If these are taken for elective reasons and primary prevention (no personal history of heart attack, stroke, or blood clot), then the over the counter blood thinners can be stopped 1 week prior to skin surgery.

For Stroke Awareness, please visit: http://www.strokeassociation.org/
STROKEORG/AboutStroke/About-Stroke_UCM_308529_SubHomePage.jsp

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