Is it possible or safe to have a blepharoplasty if I am on Coumadin?

Question

I Am a 45 Year Old Woman on Coumadin, is It Possible/safe to Have Blepharoplasty?

Ronald J. Edelson, MD · Answer

You need to be off coumadin for one week prior to surgery.  You must get the okay from your primary care physician or cardiologist, however, before stopping blood thinners.

Nima Shemirani, MD · Answer

The answer is yes, and you should coordinate with your hematologist or primary care doctor.  It just involves using a lovenox bridge, where you use lovenox while you are holding your coumadin.  The morning dose is held before surgery and usually resumed in a day.

	Best,

	Nima Shemirani

Toby Mayer, MD · Answer

Yes, you can have a blepharoplasty. Your surgeon and internist can stop the coumadin enough to let the surgery be done and then started again.

A.J. Amadi, MD · Answer

That is a question that not only is on the mind of patients, but constantly a topic of discussion among surgeons. And unfortunately, there is not an easy answer. When planning surgery, we always need to weigh the risks vs the benefits of surgery. The risk of stopping blood thinners is possible adverse blood clotting events such as stroke. Admittedly, the risk of such an event is relatively low, however the risk is there.

	The risk of not stopping blood thinners is adverse bleeding events, which around the eyes could be devastating [potential blindness]. Again, this risk is relatively low as well. Specifically, in terms of a blepharoplasty, if your surgeon is not planning on removing prolapsing orbital fat, then the risk of bleeding causing loss of vision is very low, and many surgeons around the country are increasingly willing to operate on patients who are on blood thinners.

	However, each and every patient needs to be evaluated on an individual basis, and your surgeon should discuss the pros and cons of stopping blood thinners.  In my practice, I always discuss the patient with their primary care provider or cardiologist to discuss their medical condition requiring the blood thinner and ask their advice regarding the risk of stopping the blood thinner. I then consider the surgical procedure and weigh the risk of bleeding could have towards the vision, and then make an informed decision on whether to stop the blood thinner. In each event, I will have the patient sign a form stating that we have discussed these risks and involve them in the decision making process.

	Hope this helps.

	AJ Amadi, MD FACS

Sandy Sule, MD · Answer

It is possible to have eyelid surgery while on anticoagulation. It is important, though, you are of coumadin for several days and take another medicine like lovenox.

Barry L. Eppley, MD, DMD · Answer

Performing blepharoplasty on a patient who is on anticoagulation is all about managing the stoppage and resumption of the medication. The first step is to ask your physician if you can be off Coumadin for a short period of time. If not, then you should not undergo any form of elective plastic surgery. If your physician deems it medically safe, then you need to stop taking it five days before surgery and you may resume it 48 hours after surgery, providing your physician agrees. They may recommend the use of Lovenox injections as a substitute for your Coumadin during this period based on the reason you are on anticoagulation in the first place. With this approach you can safely have blepharoplasty surgery but your risk of having more bruising or developing an actual hematoma after surgery is higher than the typical patient.

David A. Schlessinger, MD · Answer

The simple answer is yes. We can perform blepharoplastys on patients on blood thinners as long as the cardiologist or Internist allows Coumadin to be stopped for a period of time to allow normal blood clotting.

	Bleeding is one of the potential complications of blepharoplasty. In my opinion, a blepharolplasty should not be performed if coumadin can not be stopped. The risk of stopping coumadin must be discussed with the prescribing Doctor. In cases such as an arrythmia, often the coumadin can be safely stopped for a few days to allow for safe surgery. In other cases, such as patients with previous blood clots, the coumadin can not be safely stopped. The key is to have discussions with both the surgeon and the Doctor who prescribed the Coumadin.

Peter A. Aldea, MD · Answer

If you had eye surgery while on Coumadin you blood would not clot and you would end up with massive bruising around the eye (I doubt your surgeon would be dumb enough to cut the other side once encountering the bleeding). Worse yet, the rarest complication of eye surgery make be more likely. Bleeding behind the eye ball - RETROBULBAR HEMATOMA can put pressure on the back of the eyeball and result in blindness.

	The real question is NOT should you have surgery on Coumadin but can YOUR Coumadin be stopped.Coumadin is a very serious blood thinner used in cases where clots, should they form, could be life threatening. The threat of clotting if the coumadin is stopped may be great enough to stop such plans.

	Consult with the doctor who put you on Coumadin to get his opinion.

	Dr. Peter Aldea

Gregory Branham, MD · Answer

Great question. I require my paients to have their INR normalized (be completely off of Coumadin) prior to blepharoplasty. The reason for this is that any blood thinners such as asprin, coumadin, plavix, NSAIDS raise your risk for one of the worst complications associated with blepharoplasty......an orbital hematoma which can lead to blindness. When you weigh the risks associated with this elective cosmetic surgery and the risks of significiant complications it just doesn't add up. Even if you don't get this serious complication you would have much more bruising and downtime if you can't come off of the coumadin. Most patients can be off of coumadin for a period of time, although some cannot. It is essential that you discuss this with your physician who is managing your coumadin to make sure that you can come off of it preoperatively.

Francis (Frank) William Rieger, MD (retired) · Answer

Your  Internist or Cardiologist will need to be consulted before this decision can be made.  In general, blood thinners will need to be stopped for two weeks before as well as after elective surgery to minimize the tendencies for bleeding..Hematoma formation can ruin very effective surgery if it were to be severe.  This cooperative effort between your Plastic Surgeon and your Internist will be critical in making this decision for you.

	 

	Good luck to you.

Is it possible or safe to have a blepharoplasty if I am on Coumadin?

Answers (13)

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