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- Dec 5, 2020
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My aortic valve replacement surgery is coming up in 4 days. I’d love to have input from others as to what recommendations they were given prior to surgery. I’ve reviewed the limited guidance that they gave me for diet and supplements prior, took a look at what some medical sites recommend and looked for some supporting literature on the recommendations. Also, there is such an incredible wealth of knowledge on this forum pertaining to coagulation, that hopefully some with experience and knowledge of the literature can weigh in with their views and perhaps dispel some of the myths that might be being perpetuated out there. Just as much of the guidelines regarding diet and warfarin are riddled with misinformation, I suspect that much of the guidance for pre-surgery diet may also be misleading.
My Clinic:
Aside from instruction to not eat after midnight the day before surgery, my clinic has given very little guidance in their pre-surgery hand out.
“If you are taking blood-thinning medications, including aspirin, and have not received instructions about when to stop them, please contact your surgeon’s office immediately.”
And
“Please discontinue taking any herbal supplements unless instructed by your physician.” - Note, that no time frame is given- 3 days before? 1 week? 2 weeks?
Various medical sites online indicate to avoid the following:
“Green tea, cayenne, ginkgo, garlic, ginger, flaxseed, tomatoes, potatoes, and eggplant may have a negative effect on anesthesia or bleeding time.”
“Avoid all fish and flaxseeds 2 weeks prior to surgery, as these are high in Omega 3 which can affect clotting time.”
“Foods high in refined sugar should be avoided as they can suppress immune function.”
“The following food items that contain salicylates that can affect blood clotting: Almonds, Apricots, Berries (All), Cherries, Cucumbers, Grapefruit, Grapes, Lemons, Limes, Nectarines, Oranges, Peaches, Plums, Prunes, Raisins, Tomatoes, Vinegar, White carbohydrates, bagels, rice, pasta”
Almost all indicate to avoid turmeric, fish oil and aspirin and usually they say to discontinue one week prior to surgery.
My suspicion is that most of the above is not based on the literature. I did look for literature to support discontinuing fish oil, fish, flaxseed and chia seed, all of which are discouraged because they are high in Omega 3, which many claim negatively impacts clotting.
The literature does not appear to support this, at least for fish oil:
“Higher achieved n-3-PUFA levels were associated with lower risk of bleeding.”
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004584
And this study:
“Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.”
No impact of fish oil supplements on bleeding risk: a systematic review - PubMed
And some found a benefit from omega 3s:
“The authors found that omega-3 supplementation was associated with fewer post-surgical infections, as well as a shorter hospital stay.”
Is it Safe to Take Fish Oil Before Surgery & Medical Procedures?
My surgeon ordered extensive blood work which was done yesterday. I eat a big Mediterranean salad every day, which contains many of the foods that many sites warn about: loaded with garlic, onions, tomatoes and chia seeds. I also put a good chunk of salmon in each salad. As I have not yet discontinued this salad, perhaps I will bleed to death in surgery. But, my coagulation baseline bloodwork perhaps suggests otherwise, and I was even on 81mg aspirin and fish oil supplements the day they took my blood.
Two of the tests done, I believe, were to establish my baseline coagulation:
INR: My INR was 1.1 which is in the normal range for baseline.
APTT- This looks at the other coagulation pathway, which heparin interferes with.
My APTT level 24.1 seconds. The reference range is 24.4 to 36.2 seconds. So, if anything, I am clotting a little faster than normal, although I doubt this is a reason for concern.
What action I have taken based on the hand out from my clinic: I stopped aspirin 2 days ago. I stopped my turmeric supplements yesterday. I stopped fish oil supplements and fish yesterday as well, but after reading the literature I resumed again today. Holding off on garlic and onions for now, but curious what others think. It sounds like there may be some literature to suggest stopping garlic prior to surgery.
I’d love any input on what advice others were given before surgery and for those with knowledge and experience on coagulation, how much of the above pertaining to diet and supplements is baloney?
My Clinic:
Aside from instruction to not eat after midnight the day before surgery, my clinic has given very little guidance in their pre-surgery hand out.
“If you are taking blood-thinning medications, including aspirin, and have not received instructions about when to stop them, please contact your surgeon’s office immediately.”
And
“Please discontinue taking any herbal supplements unless instructed by your physician.” - Note, that no time frame is given- 3 days before? 1 week? 2 weeks?
Various medical sites online indicate to avoid the following:
“Green tea, cayenne, ginkgo, garlic, ginger, flaxseed, tomatoes, potatoes, and eggplant may have a negative effect on anesthesia or bleeding time.”
“Avoid all fish and flaxseeds 2 weeks prior to surgery, as these are high in Omega 3 which can affect clotting time.”
“Foods high in refined sugar should be avoided as they can suppress immune function.”
“The following food items that contain salicylates that can affect blood clotting: Almonds, Apricots, Berries (All), Cherries, Cucumbers, Grapefruit, Grapes, Lemons, Limes, Nectarines, Oranges, Peaches, Plums, Prunes, Raisins, Tomatoes, Vinegar, White carbohydrates, bagels, rice, pasta”
Almost all indicate to avoid turmeric, fish oil and aspirin and usually they say to discontinue one week prior to surgery.
My suspicion is that most of the above is not based on the literature. I did look for literature to support discontinuing fish oil, fish, flaxseed and chia seed, all of which are discouraged because they are high in Omega 3, which many claim negatively impacts clotting.
The literature does not appear to support this, at least for fish oil:
“Higher achieved n-3-PUFA levels were associated with lower risk of bleeding.”
https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.004584
And this study:
“Fish oil supplements reduced platelet aggregation in healthy subjects. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. Consequently, this systematic review does not support the need for discontinuation of fish oil supplements prior to surgery or other invasive procedures.”
No impact of fish oil supplements on bleeding risk: a systematic review - PubMed
And some found a benefit from omega 3s:
“The authors found that omega-3 supplementation was associated with fewer post-surgical infections, as well as a shorter hospital stay.”
Is it Safe to Take Fish Oil Before Surgery & Medical Procedures?
My surgeon ordered extensive blood work which was done yesterday. I eat a big Mediterranean salad every day, which contains many of the foods that many sites warn about: loaded with garlic, onions, tomatoes and chia seeds. I also put a good chunk of salmon in each salad. As I have not yet discontinued this salad, perhaps I will bleed to death in surgery. But, my coagulation baseline bloodwork perhaps suggests otherwise, and I was even on 81mg aspirin and fish oil supplements the day they took my blood.
Two of the tests done, I believe, were to establish my baseline coagulation:
INR: My INR was 1.1 which is in the normal range for baseline.
APTT- This looks at the other coagulation pathway, which heparin interferes with.
My APTT level 24.1 seconds. The reference range is 24.4 to 36.2 seconds. So, if anything, I am clotting a little faster than normal, although I doubt this is a reason for concern.
What action I have taken based on the hand out from my clinic: I stopped aspirin 2 days ago. I stopped my turmeric supplements yesterday. I stopped fish oil supplements and fish yesterday as well, but after reading the literature I resumed again today. Holding off on garlic and onions for now, but curious what others think. It sounds like there may be some literature to suggest stopping garlic prior to surgery.
I’d love any input on what advice others were given before surgery and for those with knowledge and experience on coagulation, how much of the above pertaining to diet and supplements is baloney?
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