Many patients need to take medications that affect how blood clots. When breast surgery is performed, it may be necessary to stop certain medications before surgery to prevent excessive bleeding during or after surgery. More common medications include:
Aspirin affects how platelets function. Platelets are important in blood clot formation. Many patients are on aspirin due to heart issues and may continue to take their aspirin. Patient’s surgeons will advise them on their specific recommendation.
Plavix also affects platelet function, but is much more potent than aspirin. Patients are usually asked to stop their Plavix 5 days prior to surgery or a biopsy. Patients who take Plavix because of a recent coronary artery stent will be at risk of the stent clotting if they stop Plavix.
Heparin, also called unfractionated heparin, affects blood clotting factors. It is given by IV (intravenous). It has a short half-life (a measure of how long it stays active in the body). For breast surgery patients, it is most often used in patients who have artificial heart valves that require blood thinning (anticoagulation).
Lovenox is a low molecular weight heparin. It is given as a subcutaneous injection (injection into the fatty tissue underneath the skin). It’s effect lasts about 12 hours. Lovenox is frequently used to “bridge” patients who are on long term anticoagulation using Coumadin, but who must stop Coumadin prior to surgery or a biopsy. It is also used to treat and prevent deep vein thrombosis (DVT) and pulmonary emboli.
Coumadin, also known as warfarin, is an oral anticoagulant that affects the Vitamin K dependent blood clotting factors. It is commonly used for conditions that require long-term anticoagulation, such as artificial heart valves, chronic blood clots and atrial fibrillation (an irregular heartbeat). It is stopped 5 days prior to surgery or a biopsy.
NOAC (Novel Oral Anticoagulants)
NOACs are new medications that affect a specific factor in the blood clotting cascade. They are highly selective and do not affect as many factors in the blood clotting cascade as Coumadin. Their advantage over Coumadin is that they do not require the blood monitoring and dose adjustments like Coumadin does.
Xeralto, or Rivaroxaban, inhibits Factor Xa. It is used to treat and prevent deep vein thrombosis and pulmonary emboli. It is a pill that should be stopped 24 hours before surgery or a biopsy.
Eliquis, or Apixaban, is also an oral Factor Xa inhibitor. It is used to treat and prevent blood clots in patients with Atrial fibrillation, deep vein thrombosis and pulmonary emboli. It is stopped 1-2 days prior to breast surgery or a biopsy, dependent on the surgeon’s recommendation.
Pradaxa, or Dabigatran, is a direct Thrombin inhibitor that is used to prevent stroke in patients with Atrial fibrillation. It is an oral pill that is stopped 1-5 days prior to surgery or a biopsy, dependent on the surgeon’s recommendation.
Patients who are on blood thinners should inform their surgeons about their medication use. Their surgeons will advise them on if and when to stop taking these medications prior to surgery or a breast biopsy.