Reducing Bleeding Risk Before Surgery
Bleeding risk is reduced through careful medication review, good blood pressure control, and avoiding substances that thin the blood or impair clotting in the days before surgery. Every case is individually reviewed at consultation, as some medications must never be stopped without the prescribing doctor's agreement.
Medications & Supplements to Stop
Never stop a prescribed medication without first checking with the prescriber or Mr Naparus — this particularly applies to blood thinners prescribed for a medical condition (such as after a stent, or for atrial fibrillation), where the risk of stopping may outweigh the bleeding risk of continuing.
Common over-the-counter and supplement culprits that increase bleeding and bruising, usually stopped around one to two weeks before surgery unless advised otherwise:
- Aspirin — unless prescribed for a specific medical reason, in which case discuss with your prescriber first
- Ibuprofen and other NSAIDs (e.g. naproxen, diclofenac) — paracetamol is a safer alternative in the lead-up to surgery
- Fish oil / omega-3 supplements
- Vitamin E supplements (in high doses)
- Ginkgo biloba, ginseng, garlic supplements and St John's Wort — all have recognised effects on bleeding or anaesthetic drug interactions
- Multivitamins containing high-dose vitamin E or fish oil — check labels
A full, current list of your regular medications and supplements should be brought to your consultation and pre-assessment, so this can be reviewed individually.
Blood Pressure Stability
Uncontrolled high blood pressure increases bleeding and haematoma risk during and after surgery. If you have known hypertension, good control in the weeks before surgery — through your regular medication, taken as prescribed — is important. Blood pressure is checked at pre-assessment, and surgery may be postponed if it is not well controlled on the day. Avoiding caffeine, alcohol and stimulants immediately before surgery, and managing pre-operative anxiety (which can itself raise blood pressure), also help.
Preventing Haematoma After Surgery
A haematoma is a collection of blood beneath the skin, and is the most common reason for an early return to theatre after some procedures. Steps that reduce this risk include:
- Careful surgical technique and, where appropriate, use of a fibrin sealant to reduce oozing
- Well-controlled blood pressure in the immediate post-operative period
- Avoiding straining, bending or heavy lifting in the first days after surgery
- Following activity restrictions exactly as advised for your procedure
- Avoiding alcohol, which affects blood pressure and clotting, in the days after surgery
Rapidly increasing swelling, tightness, spreading bruising or significant pain on one side after surgery can indicate an expanding haematoma and should be reported immediately using the contact details given at discharge — this occasionally requires prompt assessment.
Managing Bruising
Some bruising is a normal and expected part of healing after most procedures, typically most visible in the first one to two weeks and fading over two to four weeks.
- Ice — cold application in the first 24–48 hours reduces swelling and can limit the extent of bruising; always use a cloth barrier and follow the timing advised for your procedure
- Elevation — keeping the treated area elevated (for example, the head after facial surgery) reduces pooling of blood and swelling
- Arnica — a commonly used topical and oral remedy for bruising; the evidence for its effectiveness is mixed and not conclusive, though many patients use it and report it helpful. It is reasonable to use if you wish to, but should not be relied upon as a substitute for the measures above
- Laser for persistent bruising — vascular laser (such as pulsed dye laser) can accelerate resolution of stubborn bruising in some cases and may be discussed if bruising is unusually slow to clear