Blood thinners and major surgery

I know little about the protocols for a knee replacement, but I understand about DOACs quite a bit having been on apixaban for eight years now. You will receive an instruction document, probably printed, some weeks prior to the surgery. They will be detailed, and you will be expected to follow them scrupulously, even to the point of calling and seeking clarification on anything that puzzles you or that appears to be contradictory or contraindicated per your own experience and understanding.

Most surgeons require you to stop a DOAC at least a full 24 hours prior to the surgery, but you'll know how long when you receive those instructions. As for an anti-inflammatory, same thing. and you can usually recommence them within about 24-48 hours of the surgery. Because of your risk for clots and stroke, you might be asked to recommence them that evening...happened to me after both catheter ablations to treat heart arrhythmia.

You can call the office clerk any time and ask that you be pointed to a website with detailed protocol descriptions and instructions.

I don't know if this is common practice, but when I had my knee replaced, they captured all of the blood and then put it back into me. At the time I was on Remicade for ulcerative colitis, and I was off of that for 30 days prior to the surgery. Because of the impact of NSAIDs on the colon I was off of those. Only taking acetaminophen (Tylenol) for pain. After surgery and at home I had to give myself injections for a week to combat potential blood clots. This was way before my Afib episode and Eliquis.

I just had a total hip replacement (8 weeks ago), and while I had to stop Eliquis 3 days prior to the surgery, I was able to resume using it 3 days after surgery. Experienced no issues while off Eliquis. Hope this helps.

I had total hip replacement in February 2025. I have continuous afib. I was off blood thinners 3 days prior to my surgery. The day after surgery I had a stroke. I was fortunate and very lucky to have few deficits from the stroke. 2 weeks in hospital and several months of physio and occupational therapy. I'm back to normal everyday life and grateful for all the healthcare I received in Canada. I had no cost to my health care.

Hi, Z. I've also been of Eliquis for several years, and required to stop it for some minor surgeries without any complications whatsoever.

How previous poster, Gloaming, described the process is 100% on point.

All the best!

/LarryG

My husband had TKR and he was able to do well with PT after one week with only maximum strength Tylenol. I think you will be surprised at how well you will do if you do the therapy as recommended.

Surgeons are mechanics for the most part and ignore completely the rehab aspects for their patients recovery. Movement and ice packs work the best. Ice is a great way to reduce inflammation, provide immediate pain relief, and enhance circulation in the area.

When I had a torn rotator cuff the PT used ice after working the area. The dedicated physical therapy center had a very high capacity ice machine on the premises.

I buy the replaceable ice packs and keep a few in the freezer for use. These can also be placed in a microwave oven to provide heat to an area.

This is great! Thanks for all the thoughtful answers on how to deal with
post-surgery inflammation when one can’t take NSAIDs due to blood thinner
usage. Anyone use the “ice machines”?

@zacklucy YES! My husband was given an ICE machine to use for one month after surgery; it was $150 total for the month and the company came out to the house, delivered it and then picked it up at the end. It was easy to use, very portable and extremely comfortable for my husband. He used it for most of the first two weeks, and then mostly at night after that. I think it made a huge difference in his comfort. I would highly recommend that you use it. My husband's surgeon had this as part of her specific routine and he has had excellent results. Good luck!