Do you take medication that thins your blood? Then it is important to report this before an eyelid surgery. Below you will find an overview of the most commonly used blood thinners and antiplatelet drugs, and what this means for your treatment.
Which medication does this concern?
- Acetylsalicylic acid: Aspirin, Aspirin Cardio, Aspro, Ascal, and the unbranded ‘acetylsalicylic acid Cardio’
- Platelet inhibitors: clopidogrel (Plavix, Grepid, Iscover), prasugrel (Efient), ticagrelor (Brilique), dipyridamole (Persantin, often combined with acetylsalicylic acid as Asasantin Retard)
- Vitamin K antagonists: acenocoumarol (Sintrom) and phenprocoumon (Marcoumar)
- DOACs (direct oral anticoagulants): apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Lixiana)
- Low-molecular-weight heparins (LMWH, injections): nadroparin (Fraxiparine, Fraxodi), enoxaparin (Clexane), dalteparin (Fragmin), tinzaparin (Innohep)
- Other anticoagulants (injection): fondaparinux (Arixtra)
And also freely available products such as?
- Fish oil
- Ginkgo
- Vitamin E-containing preparations
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Why is this relevant?
This medication increases the risk of bleeding and bruising (haematomas) during and after the procedure. In the worst case, a bleed behind the eye (retrobulbar haematoma) can arise, a rare but serious complication [1].
Still, stopping is not always necessary. Research shows that patients who continued their antiplatelet or anticoagulant therapy had no increased risk of intra-operative bleeding or serious bleeding complications [2].
Stopping this medication also carries risks: an increased chance of thrombosis, heart attack or stroke. The consideration between these risks is always made on an individual basis [2,3].
Our protocol at Kliniek het Bolwerk
1. Complete medication inventory
We actively ask you about each of the following products, by name: acetylsalicylic acid (Aspirin, Aspirin Cardio, Ascal), clopidogrel (Plavix), prasugrel (Efient), ticagrelor (Brilique), dipyridamole/Asasantin, acenocoumarol (Sintrom), phenprocoumon (Marcoumar), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), edoxaban (Lixiana), and injections such as Fraxiparine, Clexane, Fragmin, Innohep or Arixtra. In addition, we ask about freely available products such as acetylsalicylic acid, fish oil, ginkgo and vitamin E [4].
2. Consultation with the prescribing doctor
Are you using DOACs, vitamin K antagonists or platelet inhibitors? Then, before the consultation, contact your prescribing cardiologist, internist or GP [2,3].
3. Adjusted surgical technique
With patients who continue their blood thinners, we adjust the technique: more restrained with deeper tissue, extra haemostatic agents and a pressure bandage [5].
4. Clear instructions
We give clear instructions about which medication should or should not be (temporarily) stopped, always in consultation with your doctor.
Important: never stop acetylsalicylic acid, Plavix, Sintrom, Eliquis, Xarelto, Pradaxa or comparable medication on your own initiative. This is always done in consultation with your treating doctor and the clinic.
When do we advise against the procedure (for the time being)?
- In the case of use of heavy anticoagulants shortly after a heart attack, stroke or stent placement, without consultation with the cardiologist [3]
- In the case of a combination of several blood-thinning products without clear medical coordination
- If the prescribing doctor advises against the procedure at this time
Our advice
Are you using one of the above-mentioned medicines? Bring a complete medication overview to the intake consultation at Kliniek het Bolwerk. Before the consultation, discuss with the prescribing doctor whether the blood thinners may be stopped, from when before the treatment up to how many days after the treatment. Together we look, if necessary in consultation with your doctor, at what the safest approach is for your situation.
Literature references
The publications below form the medical-scientific basis of this article:
- Complications of Blepharoplasty: Prevention and Management. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC3357590/
- Perioperative Considerations for Antithrombotic Therapy in Oculoplastic Surgery. Ophthalmic Plastic & Reconstructive Surgery. 2022. https://journals.lww.com/op-rs/fulltext/2022/05000/perioperative_considerations_for_antithrombotic.2.aspx
- Perioperative Management of Antithrombotics. American Academy of Ophthalmology, EyeNet. 2016. https://www.aao.org/eyenet/article/perioperative-management-of-antithrombotics
- Blepharoplasty (Eyelid Surgery): Details & Recovery. Cleveland Clinic. 2025. https://my.clevelandclinic.org/health/treatments/8409-eyelid-surgery-blepharoplasty
- A Delicate Balance: Oculoplastic Surgery and Antithrombotic Medications. American Academy of Ophthalmology, EyeNet. 2022. https://www.aao.org/eyenet/article/a-delicate-balance
