Which meds and supplements to pause to cut bruising and bleeding risk.
Author
Wi Young-jin · Chief director
Seoul National University College of Medicine · Seoul National University Hospital Specialist
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To jump straight to the point, it is safest to temporarily stop taking aspirin, anticoagulants, and certain herbal medicines or supplements 1 to 2 weeks before your procedure. They contain ingredients that can increase the risk of bruising or bleeding.
While filling out consent forms in the consultation room, when asked, "Are you currently taking any medications?" surprisingly many patients reply, "Not really." But then they add, "Oh, I take Omega-3 every day," or "I've been taking herbal medicine for a cold for a week." This is because they might not think of them as "medications." It is not just prescription drugs that affect your treatment results.
Medications that increase the risk of bruising and bleeding
The ones you need to pay the most attention to are medications that slow blood clotting. Antiplatelets and anticoagulants like aspirin, warfarin, and clopidogrel are prime examples. If you are taking them daily because they are medically essential, please do not stop taking them on your own, and consult your prescribing doctor first.
Among over-the-counter pain relievers, NSAIDs* like ibuprofen and naproxen should also be avoided for about a week before your procedure. Tylenol (acetaminophen) has a relatively lower risk of bruising, so it is often recommended as a pre-procedure pain reliever.
NSAID*: Non-Steroidal Anti-Inflammatory Drugs. While they reduce inflammation and pain, they also affect platelet function, making you more prone to bruising after your procedure.
Supplements are medications too
It is easy to think that supplements are safe because they are natural ingredients, but they affect your treatment results just the same. In particular, Omega-3 (fish oil), Vitamin E, ginkgo biloba extract (ginkgo), garlic pills, and ginseng tend to thin the blood. We recommend temporarily stopping them 5 to 7 days before your procedure.
Conversely, there are supplements you do not need to stop. General multivitamins, Vitamin C, and Vitamin D are usually fine to keep taking. However, if you regularly receive high-dose Vitamin C IV drips, a schedule adjustment may be needed, so please let us know before your procedure.
The blind spot of herbal medicine & health functional foods
Herbal medicine is a blind spot that is hard to track in prescription database systems. It is generally difficult to check the exact ingredients of herbal pills or decoctions, so they are often just described as "cold herbal medicine" or "restorative herbal medicine." It is safest to temporarily stop taking herbal medicine for a week before your treatment.
Among health functional foods, products that can affect blood flow or inflammation—such as collagen, enzymes, diet supplements, and immune boosters—should be treated with the same caution. The safest way is to go over all the ingredients listed on the labels together with our medical staff before your procedure.
What to do if you couldn't stop your medication
If you took medicine yesterday or today that you should have stopped, it doesn't mean your procedure must be canceled. The risk of bruising varies depending on the type of treatment, and we need to look at both the drug's half-life and the dosage to make a decision.
However, please never hide it from us. If you just assume "it will be fine" and let it slide, it becomes difficult to trace the cause if you develop worse bruising than expected after the procedure. Even if you've already arrived at the clinic, letting us know honestly can allow us to take safe measures, such as lowering the intensity of the treatment or adjusting the schedule.
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