Surgery in the Era of Blood Thinners: The Silent Risk of Aspirin and Herbal Supplements Before Entering the Operating Room

You may enter the operating room believing that you have told your doctor about all the medications you take.

And you may not give much attention to some medications and supplements, such as aspirin, certain vitamins, and herbal products. And this is precisely where a problem that was not anticipated may begin.

Aspirin and certain medications and supplements can affect platelets, blood clotting, blood pressure, blood sugar levels, or the way the body responds to anesthetic medications. That is why reviewing everything the patient takes has become an important part of safe surgical preparation.

Aspirin.. Why Can It Become So Important Before Surgery?

Aspirin is not simply a painkiller. At its antiplatelet doses, it reduces the ability of platelets to adhere and aggregate, making it an important medication for preventing certain heart attacks and strokes in specific patients. However, this effect may increase bleeding during some surgical procedures. And here, a delicate balance emerges: Stopping aspirin may reduce the risk of bleeding in some patients, but it may increase the risk of blood clots in others. Therefore, there is no valid rule that says: “Everyone undergoing surgery should stop taking aspirin.” The decision depends on the reason it is being used, the bleeding risk associated with the surgery, the risk of developing a blood clot if it is stopped, and whether the patient has coronary stents or coronary artery disease. Modern 2026 cardiovascular and surgical guidelines emphasize that the management of antiplatelet medications before surgery should balance the risks of bleeding and blood clots, and that the decision may require coordination between the surgeon, cardiologist, and the rest of the treating team.

The Bigger Problem Sometimes Is Not the Medication.. But the Word “Natural”

A patient may remember the name of aspirin because it is clearly recognized as a medication. But what about: (Garlic – Ginkgo – Ginseng – St. John’s Wort – Vitamin E – Weight-loss supplements – Bodybuilding supplements) Many patients do not consider these products “medications,” and therefore may not mention them to their doctor in the first place. And this is an important point. Some herbal supplements may affect bleeding, blood pressure, or blood sugar, while others may interact with anesthetic medications or alter the activity of certain medications in the body. Therefore, surgical preparation sources emphasize the importance of informing the medical team about all vitamins, minerals, herbs, and supplements—not only prescription medications.

Garlic, Ginkgo, and Ginseng.. They Are Not Just Herbs

Garlic, ginkgo, and ginseng are examples of products whose potential effects around the time of surgery have drawn attention in the medical literature. Some of these products may affect platelet function or bleeding, while others may interact with anesthetic medications or other medications used by the patient during or after surgery. This does not mean that every person who takes these products will experience bleeding or a complication during surgery.

But the problem is that the surgeon does not always know the actual dose or exact composition of the supplement the patient is taking, particularly with combination products or mixtures containing multiple substances. Here, failing to disclose the supplement to the medical team becomes more serious than simply forgetting a piece of information.

Vitamin E

Vitamin E is another example of a supplement that may be important when evaluating a patient before surgery.

Some medical sources list it among products that may increase the risk of bleeding, and therefore the doctor may ask the patient to stop taking it before surgery depending on the individual case and the type of procedure.

When Should I Stop the Medication?.. The Question That Has No Single Answer

This is one of the most important points. Not every medication has the same discontinuation period, and not every surgical procedure carries the same bleeding risk. Some patients also have a high risk of blood clots, making the decision to stop an anticoagulant or antiplatelet medication particularly sensitive. Therefore, a doctor may ask a patient to stop certain medications several days before surgery, while another medication may be continued until the day of surgery, and a third medication may require an entirely different plan. In some cases, particularly in patients with a history of coronary stents or coronary artery disease, the decision should be made jointly by different medical specialties. Therefore, never make the decision to stop a medication on your own. The doctor is the one who determines what should be stopped and when.

What Does the Surgeon Need to Know From You Before Surgery?

Simply put, do not wait for the doctor to ask you about everything in detail. Tell the medical team about everything you take, including: Prescription medications. Aspirin and antiplatelet medications. Blood thinners and anticoagulants. Painkillers that you take on your own. Vitamins. Minerals. Herbs. Dietary supplements. Weight-loss supplements. Bodybuilding or performance-enhancing supplements. It is best to provide the name, dose, and frequency of use, and to bring the packages with you if possible. Before surgery, the medical team does not look only at the risk of bleeding; there are other potential risks as well. That is why reviewing medications and supplements is not merely a routine procedure before entering the operating room, but rather part of assessing the risks surrounding surgery and anesthesia.

In the End…

Surgery does not begin with the first surgical incision.. it begins much earlier.. When the doctor sits with the patient and learns about their medical history, medications, and supplements, including what may seem to the patient like nothing more than a vitamin or a natural herb. Because in the operating room: (Information that may seem minor to the patient can be extremely important to the surgeon.)