"Are you taking any medication?" "No, nothing." And ten minutes later, once the conversation has moved on, out come the blood-pressure tablet, the ibuprofen for a bad back and the fish-oil capsules started back in January.
It is not that people lie. It is that "medication" sounds like a prescription and a pharmacy, and vitamin E, garlic capsules and the bottle a relative brought back from a trip do not fit that description. The trouble is that your clotting does not distinguish between what came with a prescription and what did not.
What does get stopped
Almost everything stopped before surgery is stopped for the same reason: because it makes you bleed more. Bleeding more than expected does not only complicate the operation; it is what later turns into a haematoma, and a haematoma is the complication that most often means going back to theatre.
- Aspirin and antiplatelet drugs. Aspirin disables platelets for their entire lifespan, which is about seven to ten days. So not taking it today is not enough: it has to be stopped a good week in advance. And if you take it because someone prescribed it for your heart, that decision is neither yours nor mine: it belongs to the doctor who prescribed it.
- Anti-inflammatories. Ibuprofen, naproxen, diclofenac, ketorolac. They affect platelets reversibly and for a shorter time, but they do affect them. They are usually stopped a few days beforehand. Paracetamol is not on this list and covers most of what you might need in the meantime.
- Anticoagulants. Warfarin, rivaroxaban, apixaban and the rest. Here the rule is the opposite of what it looks like: never stop them on your own. Coming off an anticoagulant abruptly can be considerably more dangerous than the surgery. They are coordinated with the cardiologist or haematologist who prescribed them, sometimes by swapping to another drug for a few days, and that coordination takes time: you mention it when you ask for a date, not the week before.
- Contraceptives and hormone therapy. Not for bleeding but for the opposite: they raise the risk of thrombosis, and long surgery with several hours of immobility raises it too. For major operations you will usually be asked to stop them weeks in advance, with an alternative method in place. For small procedures it is often unnecessary.
- Weight-loss products and pre-workouts. The ones with stimulants push up your blood pressure and heart rate, which is exactly what the anaesthesiologist spends the whole operation keeping steady. And the ones bought online rarely declare everything they contain.
The drug that genuinely complicates an operation is almost never the one on the list. It is the one that went unmentioned because it did not look like one.
What does not get stopped, said just as plainly
There is a widespread and dangerous idea that you have to "clear everything out" before an operation. You do not. Several long-term treatments are continued right up to the day itself, and stopping them is worse than carrying on.
- The blood-pressure tablet. Most are taken on the morning of surgery with a sip of water. Arriving in theatre with your blood pressure through the roof because you dropped it two days earlier is a real problem. Some specific groups of drugs are adjusted, and that is the anaesthesiologist's call.
- Thyroid medication. Taken as usual.
- Anti-epileptics, antidepressants and antipsychotics. Continued. Stopping an antidepressant abruptly has a withdrawal syndrome of its own, and the days after an operation are the worst possible time to go through it. If one of them interacts with the anaesthetic drugs, the anaesthetic is adjusted, not your treatment.
- Inhalers. Bring them on the day and use them before going in if you need to.
- Diabetes. Not stopped: reorganised. Since you will be fasting, the doses and timings for the day before and the day itself change, and those instructions are given to you in writing.
The ones nobody mentions
This is the list that always gets left out, and the one that produces the most surprises. Several over-the-counter products affect clotting enough to show up during surgery:
- Vitamin E at high doses.
- Omega 3, fish oil, krill oil.
- Garlic capsules, ginkgo biloba and ginseng.
- Concentrated turmeric and ginger, which is not the same as cooking with them.
- St John's wort, which also interacts with several anaesthetic drugs.
- Cat's claw, maca and herbal preparations with no declared composition. Here the problem is not what is known about them but what is not: if the label does not say exactly what is in it and how much, there is no way to work anything out.
Supplements are usually stopped a couple of weeks beforehand. Not because they are dangerous in everyday life, but because in an operation they add nothing and can subtract.
How far in advance
The timings above are the usual ones, not a table that applies to everybody. They change with the operation — removing a mole is not an abdominoplasty — with why you take each thing, and with what your cardiologist says if you have one.
That is why the conversation about medicines happens when you ask for a date, not at the last consultation. An anticoagulant that has to be coordinated with another specialist is not sorted out in forty-eight hours, and an operation postponed for that reason is postponed by weeks.
How to bring the list without forgetting anything
One method works far better than trying to remember: gather every box and bottle on the table and photograph them with your phone. All of them, including what is in the bathroom cabinet that you take occasionally and whatever is on the bedside table.
That photo says in ten seconds what a conversation does not manage in ten minutes: the exact name, the dose and the form. And it avoids the commonest mistake, which is confusing two drugs with similar brand names.
The same goes for the things that are hard to say. If you take something to sleep, if you drink more than you would admit out loud, if you use anything recreational. It does not change how you are treated and it is not discussed with anyone. It changes the dose of anaesthetic, and that is precisely the information no blood test can reveal.