OpenHealth Q&A

Debating Blood Thinners Post-Surgery: Aspirin vs. Eliquis

A 50-year-old man is scheduled to undergo surgery next week to fix a partially detached bicep and a torn rotator cuff. Seventeen months prior, the same surgeon performed a procedure for a torn labrum and detached bicep on his other shoulder, after which he was prescribed Eliquis. He can't recall whether he was on it for 14 or 30 days, but it was following a history of a blood clot that occurred in his right index finger at the age of 25. Recently, during the pre-operation consultation with the surgeon's physician assistant, he was given a recommendation to take 325 mg of aspirin instead. The assistant explained that this choice was acceptable since he has not experienced any symptoms from the previous clot. To confirm this change, he reached out to the surgeon’s office, where a nurse reaffirmed the aspirin recommendation and mentioned that Eliquis could be prescribed if he preferred it. To provide some context, at the age of 25, he consulted a physician about the tingling and numbness he was feeling in the upper part of his index finger. After undergoing a CT scan with contrast, he was referred to a hematologist who put him on Coumadin. He continued with regular blood tests for about a year before discontinuing the medication due to lack of insurance and frustration with its restrictions. He then resorted to taking a low-dose aspirin daily. Unfortunately, after moving 900 miles away five years later, he encountered difficulty obtaining his medical records due to the closure of his previous doctor's clinic. Consequently, he continued with aspirin, without experiencing further issues, though noticed that finger tended to feel colder than his other fingers. It wasn’t until having bilateral hip replacement surgery in 2022 that he realized he wasn’t prescribed Eliquis or Coumadin afterward. He recognizes that there is a delicate balance between managing clot risk and potential bleeding. However, he finds it perplexing that the same surgeon would suggest differing post-operative medications for similar procedures conducted just over a year apart. His main concerns revolve around whether the risk of clots is significantly elevated when using aspirin alone or if the bleeding risk associated with Eliquis is deemed too high. He feels hesitant about questioning his surgeon and ultimately seeks reassurance that the choices made were in his best interest, which would help him to approach the upcoming surgery with confidence, remembering how smoothly his recovery had gone previously.

Answers (1)

3/25/2025, 6:30:46 PM

OpenHealth AI

It's understandable that you're feeling uncertain about the choice between aspirin and Eliquis for post-surgery blood thinning. Here's a breakdown of the important points regarding your situation, along with clear next steps to help you feel more confident moving forward.

Main Points:

• Blood Thinning Options: Aspirin is an antiplatelet medication that helps prevent blood clots, while Eliquis (apixaban) is a direct oral anticoagulant, which is usually more effective at preventing clots in patients with a history of thrombosis.
• Risk Assessment: Your history of a blood clot raises valid concerns about the risk of clots post-surgery. However, the decision to use aspirin instead of Eliquis may reflect a lower overall risk assessment by the surgical team, based on your current health status and recent medical history.

Explanation:

Aspirin works differently than Eliquis. While aspirin reduces the risk of clots, it is generally considered less effective in preventing serious clots in those with a significant clotting history. Eliquis is usually prescribed for higher-risk patients but does carry a greater risk of bleeding complications. Your surgeon’s recommendation likely considers both the risks of clots and the potential for bleeding based on your specific medical history.

Next Steps:

1. Clarify Your Risk Profile: Write down any questions or concerns regarding your personal risk factors for blood clots versus the bleeding risks associated with Eliquis. This will help you have a focused discussion with your surgeon or a hematologist.

2. Consider a Follow-Up Appointment: If possible, request a brief follow-up consultation with the surgeon or their team. You can express your concerns about the differences in medication recommendations and re-evaluate your history of blood clotting and surgery.

3. Monitor Symptoms: After surgery, if you notice any unusual symptoms such as extreme swelling, pain, or prolonged discomfort in your arm, be sure to contact your healthcare provider immediately.

4. Stay Informed and Confident: Educate yourself more about the differences between aspirin and Eliquis. Understanding their mechanisms can help you feel more at ease in discussions with your healthcare team.

It's completely normal to feel concerned about your surgical recovery, especially given your past experiences. You're taking a proactive approach by seeking information, and that will serve you well as you navigate your care. Remember, your health and comfort are paramount.