Anticoagulant & Antiplatelet Medications
When to stop and restart blood-thinners before surgery — aspirin, Plavix, Eliquis, Xarelto, Pradaxa, Coumadin.
Download this guide (PDF)Blood Thinners and Surgery
A quick-reference guide to anticoagulants, antiplatelet medications, and surgery.
Cotton O'Neil Neurosurgery and Spine Center — Stormont Vail Health
Why this matters
Blood-thinning medications save lives — they prevent strokes, heart attacks, and blood clots. They also increase bleeding risk during surgery. Stopping them safely requires a plan that considers both your bleeding risk and your clotting risk.
Do not stop any cardiac or anticoagulant medication on your own. Stopping these without medical guidance can cause stroke or heart attack. Always confirm timing with the prescribing physician.
General timing
All of the timing below is a default. The pre-anesthesia team's instructions, and any guidance from your cardiologist or hematologist, override what is on this sheet.
Antiplatelet medications
| Medication | Stop how many days before surgery | Confirm with |
|---|---|---|
| Aspirin (low dose, 81 mg) | 7 days | Cardiologist if you have stents |
| Aspirin (full dose, 325 mg) | 7 days | Cardiologist if you have stents |
| Plavix (clopidogrel) | 7 days | Cardiologist required |
| Brilinta (ticagrelor) | 5 days | Cardiologist required |
| Effient (prasugrel) | 7 days | Cardiologist required |
| Aggrenox (aspirin/dipyridamole) | 7 days | Cardiologist |
Direct oral anticoagulants (DOACs)
| Medication | Stop how many days before surgery | Notes |
|---|---|---|
| Eliquis (apixaban) | 3 days (72 hours) | Longer if kidney function is impaired |
| Xarelto (rivaroxaban) | 3 days (72 hours) | Longer if kidney function is impaired |
| Pradaxa (dabigatran) | 3 days (72 hours) | Longer if kidney function is impaired |
| Savaysa (edoxaban) | 3 days (72 hours) | Longer if kidney function is impaired |
Warfarin (Coumadin)
- Stop 5 days before surgery.
- Get an INR check the day before to confirm it has dropped into the normal range.
- For high-clotting-risk patients (mechanical valve, recent clot, atrial fibrillation with prior stroke), bridging with injectable enoxaparin (Lovenox) may be needed during the off-warfarin window. Your prescriber will arrange this.
Other agents to mention
- NSAIDs (ibuprofen, naproxen, meloxicam, diclofenac, celecoxib): stop 7 days before.
- Aspirin-containing cold/flu products (Excedrin, BC Powder, Goody's): stop 7 days before.
- Fish oil, vitamin E, ginkgo, garlic supplements, high-dose turmeric: stop 7 days before — they affect platelet function.
When to restart
You will be told when to restart each medication based on your bleeding risk after surgery, your clotting risk, and the type of operation. Do not restart on your own.
Typical timing for low-bleeding-risk operations:
- Aspirin, NSAIDs: 24–48 hours after surgery
- Plavix, Brilinta, Effient: per cardiology
- Eliquis, Xarelto, Pradaxa: 1–2 days after surgery
- Warfarin: the evening of or day after surgery
For neurosurgical operations, restart timelines may be longer. Always follow your discharge instructions.
High-risk situations — call before stopping
Talk to your cardiologist (or our office) before stopping any of these if you have:
- Coronary stents placed in the last year — stopping antiplatelets early can cause stent thrombosis, a heart attack.
- A mechanical heart valve.
- Atrial fibrillation with a prior stroke.
- A blood clot in the last 3 months (DVT or pulmonary embolism).
- A bleeding disorder (hemophilia, von Willebrand, ITP, etc.).
For these situations, bridging therapy or a modified plan is the norm — not the exception. Build in extra time for coordination.
What to bring to your pre-op visit
- A complete list of every medication and supplement you take, with doses and how often.
- Names and contact information for your cardiologist, hematologist, or other prescribers.
- A recent INR if you are on warfarin (within the last month is ideal).
- Any prior bridging plans that have been used for previous surgeries.
When to call us
Call our office at (785) 368-0767 if:
- You are unsure whether to stop a medication and the pre-anesthesia visit is more than 48 hours away.
- You took a medication that was supposed to be held — we may need to reschedule, or we may not. Either way we need to know.
- You develop bleeding (gums, urine, stool) after stopping a blood thinner — usually this is harmless, but tell us.
For severe bleeding, chest pain, weakness, or symptoms of a stroke, call 911.
Cotton O'Neil Neurosurgery and Spine Center — Stormont Vail Health Cotton O'Neil Kanza Park · 1st Floor · 2660 SW 3rd St · Topeka, KS 66606 · (785) 368-0767 chadtuchekmd.com
This handout provides general guidance for patients of Dr. Chad Tuchek at Cotton O'Neil Neurosurgery and Spine Center, Stormont Vail Health. It is not individualized medical advice. Always follow the specific instructions you receive from your surgeon, the pre-anesthesia team, and the physician who prescribes each medication. For medical emergencies, call 911.
Written by Chad Tuchek, MDv1.0
Reviewed July 11, 2026