Blood Thinners & Supplements to Avoid Before Surgery: What to Stop and What’s Safe

Key Takeaways

  • Blood thinners and some herbs can cause excessive bleeding and interfere with anesthesia, so check and stop such products prior to surgery. Provide your surgical team with a full list.
  • Cease most blood-thinner supplements, such as fish oil, ginkgo, and vitamin E, at least two weeks prior to surgery. Cease garlic, ginseng, and similar supplements one week prior unless your surgeon instructs otherwise.
  • Keep your blood pressure and blood sugar in check in the weeks prior to surgery, and collaborate with your provider to adjust or pause medications that affect cardiovascular or glucose control.
  • Even non-blood-thinning supplements, such as sedatives, immune boosters, and unregulated formulas, can change anesthesia or cause complications. Reveal all remedies, including OTC and herbal products.
  • Think surgeon-approved alternatives that do not increase surgical risk, like arnica for bruising, bromelain for inflammation, probiotics for gut health, and vitamin C for wound healing.
  • Maintain a current, comprehensive medication and supplement list and review it with your surgeon and anesthesiologist to minimize complications and promote optimal recovery.

Blood thinner supplements before surgery are dietary items that can impact coagulation and increase bleeding risk during operations.

Typical culprits are fish oil, garlic, ginkgo, and vitamin E, all with varying mechanisms and dose effects.

Patients frequently don’t disclose this information to clinicians, which can alter medication regimens and the timing of procedures.

Clear communication with the surgical team and a plan to stop or adjust supplements generally minimizes complications and directs safe care.

Surgical Risks

Surgery is risky. Surgical procedures have very specific, controllable risks and blood thinner supplements add their own risks that impact bleeding, anesthesia, blood pressure, and drug interactions. Knowing how supplements and medications alter surgical risk is critical for good outcomes and faster recovery.

Bleeding

Blood thinners, herbs, and some vitamins increase the risk of heavy bleeding during and after surgery. This means more blood loss in surgery, more need for transfusion, and delayed wound healing. Hawthorn extract and garlic have been associated with increased bleeding in the operating theater.

Fish oil is a known antiplatelet agent, although the clinical evidence of harm is mixed. Others such as ginkgo biloba, St. John’s wort, and cranberry have ambiguous influences but deserve caution.

  • Common supplements and medications that increase bleeding risk:
    • Garlic (raw or concentrated supplements)
    • Fish oil / omega-3 supplements
    • Ginkgo biloba
    • Vitamin E in high doses
    • NSAIDs
    • Prescription blood thinners (warfarin, direct oral anticoagulants)

Go over everything, even OTCs and supplements for blood thinners. Create one concise list of every pill, patch, cream, and herbal product you use. Provide that list to both your surgeon and primary care physician well in advance of the operation.

Anesthesia

Certain supplements and medications alter anesthetic agents or increase the possibility of complications. They can accelerate or decelerate liver enzymes that metabolize anesthetics, alter heart rate and blood pressure, or even interact directly with sedatives.

For instance, St. John’s wort can mess with drug metabolism, while other herbs might impact blood pressure or platelets, which makes anesthesia care difficult. Improper medication management can cause inadequate pain control, anesthesia awareness or hemorrhage.

Inform your anesthesiologist of any recent supplement and medication use, even those recently discontinued. Many clinicians err on the side of caution and advise discontinuing nonessential herbal supplements at least two weeks before surgery.

Blood Pressure

Certain supplements and slimming aids may increase or decrease blood pressure and create cardiac arrhythmias. Uncontrolled blood pressure raises the risk of bleeding, stroke and cardiac events during surgery and can necessitate delay of elective procedures.

Track blood pressure in the pre-surgical weeks, and with your clinician, suspend or adjust agents that impact it under medical supervision.

Drug Interactions

Despite its safe reputation, interactions between supplements, prescription blood thinners, and anesthetic drugs can lead to serious side effects or diminished drug effectiveness. Examples include warfarin with herbal supplements that increase bleeding or St. John’s wort decreasing levels of certain anesthetic agents.

  • Problematic combinations:
    • Warfarin and garlic or ginkgo.
    • DOACS and NSAIDs.
    • St. John’s wort and some anesthetic agents.

Go over all prescriptions, OTCs, and nutraceuticals. Maintain an updated medical record to assist the surgical team in planning and preventing complications.

Supplements to Pause

A lot of popular vitamins and herbs have the ability to increase or decrease bleeding risk, interact with anesthesia or impact how prescription medications function. Pausing supplements prior to surgery decreases the risk of uncontrolled bleeding, hypotension, or modified drug concentrations under anesthesia. Use the timelines below and discuss all supplements with your surgeon or prescribing clinician.

1. Fish Oil

Fish oil and omega-3 supplements thin the blood and make platelets less sticky, meaning you will bleed longer during and after surgery. Stop fish oil capsules or tablets 2 weeks before the procedure to allow clotting function to return closer to baseline.

Fish oil interacts with blood thinners like warfarin or clopidogrel, increasing bleeding risk, so coordination with the prescribing clinician is key if you take those medications. Continued use prior to surgery may delay wound healing and complicate intraoperative hemostasis, especially in surgeries with a high bleeding risk.

2. Vitamin E

Vitamin E influences platelet aggregation and increases the risk of intraoperative bleeding. Stop vitamin E supplements and any multivitamin containing high doses of vitamin E at least two weeks before surgery.

Vitamin E has the potential to stack with other blood thinners and some medications, amplifying bleeding risk, and clinicians frequently recommend pausing it alongside other anticoagulant supplements. Follow your surgical team’s med tweaks closely to eliminate preventable complications.

3. Garlic

Garlic supplements have natural antiplatelet effects and can cause increased bleeding during surgery. Pause garlic tablets, capsules, or concentrated extracts in the weeks leading up to elective surgery.

Garlic can interact with anticoagulants and some anesthetic agents and potentiates with other blood thinners such as fish oil. Steer clear of garlic in the weeks leading up to facial plastic procedures or any surgery where mild bleeding can impact results.

4. Ginkgo Biloba

Ginkgo biloba blocks platelets and has been associated with fatal bleeding in surgery. Discontinue ginkgo well in advance of the surgery, typically at least two weeks, to reduce bleeding complications.

Ginkgo interferes with prescription blood thinners and nonsteroidal anti-inflammatory drugs and might induce a reaction with anesthesia. Disclose ginkgo use so anesthesiologists can strategize drug selections and dosing.

5. Ginseng

Ginseng can alter clotting and cardiovascular responses, potentially leading to bleeding or impacting heart rate and blood pressure. Ginseng supplements, teas, and extracts should be discontinued prior to surgery, with ample time for the effects to wear off.

Ginseng supplements can affect medications such as diabetes treatments, blood pressure medications, and anesthetic agents. Ceasing ginseng lessens the possibility of hypoglycemia or hypotension during care. Remove ginseng from your diet if clinically indicated.

6. Turmeric

Turmeric has mild antiplatelet effects and enhances surgical bleeding risk when consumed as supplements or concentrated extract. Pause turmeric capsules, powders, and strong teas too before surgery.

Turmeric can interact with anticoagulants and anti-inflammatory drugs and shouldn’t be used for pain or inflammation in the perioperative period.

7. St. John’s Wort

St. John’s Wort changes drug metabolism and can conflict with anesthesia, antidepressants, and pain medications. Pause St. John’s Wort prior to surgery to prevent erratic interactions and decreased effectiveness or increased toxicity of perioperative medications.

This herb alters how the liver handles numerous medications, thus requiring careful drug monitoring when it has been taken recently.

The Discontinuation Timeline

Preoperative planning involves a strategic discontinuation timeline for any blood thinning supplements and medications to reduce bleeding risk and aid healing. Different time frames apply for different substances, dosages, and procedures. Listen to your surgeon and prescribing doctor for final decisions.

Two Weeks

Discontinue most blood thinning supplements at least two weeks prior to surgery, such as fish oil, ginkgo, and vitamin E. High-dose omega-3s greater than three grams per day in particular probably require the full 14-day discontinuation period so platelet activity can come back toward baseline.

Aspirin usually needs to be discontinued for two weeks as well unless it is indicated for documented cardiac protection where the cardiologist and surgeon must balance the bleeding versus clot risk and possibly recommend continuing aspirin.

Double check any herbs and supplements you’re taking. A lot of plant extracts don’t get listed as ‘blood thinners’ but do indeed thin your blood. In your medical record, add every suspended product and dose so the surgical team gets a true pre-op snapshot.

One Week

Stop other supplements and some medications 1 week before surgery. Things that are commonly discontinued at this point are garlic supplements and ginseng.

Most NSAIDs, including ibuprofen, are to be discontinued roughly 7 days in advance as they impact platelet function and prolong bleeding time. Look for stealth agents in cold, sinus, and slim pickings. At least a few contain salicylates or herbal extracts that thin blood.

Clopidogrel (Plavix) is typically held 7 to 10 days prior to surgery, so try to synchronize its cessation with this 1 week window. Verify the entire list with the surgical team, particularly if you are on prescription blood thinners or medications for heart disease.

The Day Before

Stop all non-essential supplements, vitamins, and herbals the day prior to surgery. Only take medications explicitly approved by the surgeon or anesthesiologist. Acetaminophen is typically permitted as a non-bleeding pain or fever alternative.

Ready and bring a final list of all recent medications and supplements for the anesthesiologist, including when the last dose was taken and how much. Xarelto (rivaroxaban) and Eliquis (apixaban) are usually discontinued 2 to 3 days prior, but if anything changes, record it here.

Individualize plans for Coumadin (warfarin), often with INR checks and specific timing. Blood thinners can frequently be restarted 24 to 72 hours postoperatively contingent on bleeding and wound stability.

For minor oral or dermatologic procedures, holding anticoagulants is sometimes not necessary. These decisions must be made on a case-by-case basis with the prescribing provider.

Beyond Blood Thinners

Patients believe only blood thinners matter pre-op. Other supplements and medications can alter anesthesia, healing, or bleeding risk. Beyond Blood Thinners Check all the products you take — herbs, nutraceuticals, topical remedies, and OTC blends — because safe perioperative care considers more than clotting.

Sedative Herbs

Valerian, kava, and passionflower are typical sedative herbs that can interact with anesthesia as well. These herbs can deepen sedation or cause erratic drops in blood pressure with anesthesia. St. John’s Wort, in addition to affecting drug metabolism, can indirectly impact anesthetic levels.

Discontinue sedative herbal supplements a few days prior to surgery. For kava and St. John’s Wort, mention lengthier discontinuation due to enduring drug interactions. These medications can exacerbate anesthesia and put patients at risk for falls or pneumonia during recovery.

Other sedatives are in multi-ingredient products or in counter formulas marked as “night blends.” Read labels carefully. Taking sedative herbs out of the equation not only makes it safer, it makes it easier for anesthesiologists to plan dosing.

Immune Boosters

While echinacea, elderberry, high-dose vitamin C, and some mushroom extracts are taken to strengthen immunity, they can modulate immune response in the perioperative period. Immune-stimulating or immune-modulating products may impact inflammation, wound healing, or interact with perioperative antibiotics.

Pause immune boosters at minimum several days to a week prior to elective procedures. For strong or long-lasting formulas, consult your surgeon for precise timing. Certain immune agents can provoke allergic reactions in the operating room or complicate infection control.

Some immune products have antiplatelet effects or mix badly with antibiotics and anesthetics. Reveal elderberry syrups, echinacea capsules, and any herbal immune blends to your surgical team for customized advice.

Blood Sugar Modifiers

Chromium, cinnamon, berberine and a few herbal formulas mess with blood glucose and insulin response. For diabetes or antihypertensive medications, for example, these products may necessitate dose changes prior to surgery. Unstable glucose not only increases infection risk, but it can delay wound healing.

Don’t initiate new or uncontrolled blood sugar formulas in the perioperative period. Check blood sugar more often if you’re taking glucose-altering supplements, and communicate adjustments with your care team. Certain metabolic health-targeted supplements include antiplatelet or bleeding risks. Curcumin and CBD oil, for instance, can enhance bleeding propensity.

Numerous patients overlook topical or single-dose remedies like arnica montana or baical skullcap root that could require avoidance. Beyond blood thinners, inform clinicians on every supplement. Typical guidance is that blood-thinning herbs should be discontinued at least 2 weeks before surgery, and many supplements one week prior.

A Surgeon’s Perspective

Surgeons are going to need a clear picture of all substances used by a patient prior to any procedure. Even “harmless” supplements can modify bleeding risk, interact with anesthesia, or impact wound healing. This section explains what surgeons request, why it is important, and how patients and teams collaborate to minimize risk and maximize outcomes.

Full Disclosure

Give your surgeon a complete list of prescriptions, OTC drugs, vitamins, herbal supplements, and topical medications. This list allows the team to provide specific guidance on what to discontinue, continue, or adjust prior to surgery. Undisclosed items can lead to last-minute cancellations, unexpected bleeding, or interactions in the OR.

Keep the list updated: add new items, note doses, and bring the list to each preoperative visit. For instance, surgeons will point out that fish oil plays a role in clotting and that over-the-counter pain relievers might need to be suspended.

The “Natural” Myth

Natural does not equal safe. Many herbs and vitamins have strong biological effects. Ginkgo biloba and garlic supplements can increase bleeding. Ginseng may affect blood sugar and interact with drugs.

St. John’s Wort alters the metabolism of anesthetic agents and other medicines. Vitamin E and turmeric or curcumin might affect clotting. Think of supplements as prescriptions and anticipate the same interrogations and precautions. Talk about them so the surgery and anesthesia teams can evaluate interactions and timing for safe cessation.

Unregulated Formulas

OTC supplements are notorious for non-standard dosing and quality. Other brands may have more or less active compounds, toxins, or even unlisted ingredients. This variability makes it impossible to anticipate surgical impact.

Select respected makers when you can, but pre-op, quit suspect concoctions and heed direct instructions from your team. Cautious medication management before and after surgery reduces the risk of delayed healing or errant bleeding.

Your Surgical Team

We work with anesthesiologists, endocrinologists, and primary care doctors to devise a safe perioperative plan. For diabetics or other chronic illnesses, medication changes might be necessary in the fasting situation on surgery day.

They will tell you when to discontinue supplements, usually it is two weeks for ginkgo, garlic, and ginseng, and recommend safer pain remedies such as acetaminophen. This open dialogue facilitates personalized bleeding risk evaluation, contingency strategy, and striving for an optimized surgery with limited complications.

Safe Alternatives

Safe alternatives are ones that do support recovery but don’t increase bleeding risk or interact with anesthesia. Here are some of the most popular supplements and sensible advice to assist patients and clinicians in selecting safer options pre- and post-surgery.

  • Arnica montana (topical or homeopathic oral) is effective for bruising and swelling.
  • Bromelain (pineapple enzyme) to reduce inflammation and swelling.
  • Probiotics to support gut flora and immune function.
  • Vitamin C to aid wound healing and tissue repair.
  • Melatonin, turmeric, bilberry, chamomile, and fenugreek have minimal evidence and a low bleeding risk.
  • Fish oil has antiplatelet effects observed. The majority of research demonstrates no heightened surgical bleeding risk.
  • Vitamin E from foods, such as almonds, sunflower seeds, and whole grains, is a safer alternative to high-dose supplements.

Always stick to supplements specifically approved by your surgeon or surgical team. Approval ought to be for the specific product, form, dose and timing in relation to the procedure. This avoids invisible crossfires with anesthesia, medications or the operative strategy.

Safe alternatives can aid healing and symptom relief without sacrificing safety or outcomes when applied under medical supervision.

Arnica Montana

Arnica will help minimize bruising and swelling after facial or makeup treatment. Research and clinical practice lean towards topical arnica gels or diluted homeopathic drops for localized impact.

Arnica is not a blood thinner and does not interfere with common anesthesia medications. The surgical team needs to verify the approved form and dosage. Use only what the surgeon states are okay and discontinue oral forms if recommended.

Topical forms can be used throughout following their instructions to aid healing and provide mild pain relief.

Bromelain

Bromelain is a proteolytic enzyme from pineapple that could reduce inflammation and accelerate recovery. Research indicates it doesn’t appreciably affect clotting at typical doses and generally does not interfere with standard medications.

Verify timing and dose with the surgical team, particularly if you’re taking other anti-inflammatories. Bromelain can decrease swelling and aid healing when incorporated into a surgeon-approved regimen.

Probiotics

Probiotics are important for gut health and immune defenses in perioperative care. They typically don’t mix with anesthesia or with prescription blood thinners.

Safe Alternatives: Opt for trusted brands with transparent strain labeling and dosage verified by the surgical team. Probiotics can cut infection risk, help antibiotic recovery, and hold digestion stable throughout the surgical period.

Vitamin C

Vitamin C aids in collagen production and immune function, both critical in wound healing and infection prevention. It’s not a blood thinner and doesn’t interfere with anesthesia at recommended dosages.

Stick to daily guidelines unless a clinician recommends higher. Whether as food or measured supplements, both help repair tissue and reduce complications when incorporated into a surgeon-approved regimen.

Conclusion

Quitting these supplements before surgery reduces bleeding risk and helps surgery go smoother. Talk to your surgeon and the practitioner who handles your medications. Include any herbs, vitamins, or over-the-counter pills you consume. Be guided by your team’s timeline. For example, discontinue fish oil and vitamin E approximately one week prior to low-risk operations and two weeks prior to major surgeries. Hold garlic, ginkgo, and high-dose vitamin C, as recommended. In the meantime, trade in safer alternatives such as topical treatments or low-dose paracetamol for pain. Track your supplements and bring a list of any changes to your pre-op visits. Simple, advance discussion with your care team protects your safety and peace of mind. Call your provider today to verify which supplements to discontinue and when.

Frequently Asked Questions

Do I need to stop all supplements before surgery?

You might have to stop blood thinner supplements prior to surgery, such as aspirin, fish oil, vitamin E, garlic, ginkgo, and some herbal supplements. Listen to your surgeon or anesthetist’s advice before discontinuing anything.

How long before surgery should I stop blood-thinning supplements?

Typical advice is 7-14 days for a lot of herbs and supplements. Exact timing depends on the product and dose. Check with your surgical team for precise timing.

Are prescription blood thinners different from supplements?

Yes. Prescription blood thinners, such as warfarin and DOACs, need medical management and a personalized plan. Do not discontinue prescription blood thinners unless explicitly instructed to do so by your prescribing clinician.

Can I take multivitamins the day of surgery?

Most simple multivitamins are low risk. Some include vitamin E or herbal extracts that influence bleeding. Review the label and consult your care team before continuing any supplement on surgery day.

What if I forgot to stop a supplement before surgery?

Inform your surgical team right away. They will evaluate bleeding risk and determine if they need to postpone surgery or be particularly vigilant in the operating room.

Are there safe alternatives to stopping supplements for surgery preparation?

Safer alternatives include switching to evidence-based measures: good hydration, optimized nutrition, and following preoperative fasting guidelines. Discuss any planned substitutes with your surgeon.

Will stopping supplements increase my surgical risk in other ways?

It’s not going to hurt you to stop most supplements for a short period. For supplements used to treat medical conditions such as omega-3s for heart health, discuss with your doctor to weigh bleeding risk against managing the underlying condition.