From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Preparation for Surgery
Date: Wed, 17 Apr 2002 13:45:15 -0600
Message-ID: <a9kjd1$jqj$1@slb4.atl.mindspring.net>

"Richard Cavell" <richardcavell@mail.com> wrote in message
news:a9j824$if$1@otis.netspace.net.au...
> > What medicines and supplements should be avoided before surgery? There
> > seem to be some differences of opinion.
>
> There's a long list, but it depends on the type of operation and the
> type of anaesthetic.
>
> > One that is not disputed, that everyone agrees to---avoid NSAIDs two
> > weeks before surgery.

COMMENT


Sorry, but it depends on the NSAID. Aspirin will hurt your bleeding time for
2 days; possibly longer if your platelet numbers or production is abnormal.
Aspirin is very different than other NSAIDs because its action is
irreversible in platelets-- a single aspirin dose (more than 1/8th of a
standard tablet) slightly disables every platelet in your body permanently,
so that somewhere around a quarter of your platelets must be replaced before
the body is back to normal bleeding times (for which you need less than a
quarter of your normal platelets...). Many other NSAIDs (ibuprofen) only
cause problems while they're in your system-- less than a day. A few
non-aspirin salicylates (eg salsalate) and COX-2 inhibitors (Vioxx) have
very little effect on platelets and are perfectly fine to take when having
dental and other procedures.


> In general.
>
> I saw a patient who had 4 teeth extracted while fully anticoagulated with
> warfarin (INR ~3.5).  I saw him several hours later, when he was bleeding
> uncontrollably.
>
> (He had transposition of the great vessel repair at birth).
>
> It depends on the relative risk of stopping the anticoagulation versus
> continuing it.

And it also depends on the surgery. Standard abdominal surgery where
bleeding is controlled with vessel ligation/ cautery and direct
visualization of bleeders, has very little more bleeding with or without
aspirin (this has been studied). Surgery in which bleeding must be
controlled from large raw surfaces by direct pressure only (tooth
extractions, liposuction, facelifts) have a huge aspirin effect, and that is
why dentists and plastic surgeons are relatively more crazy about aspirin
and other NSAIDs than are other kinds of surgeons. FYI.


> > Some also say avoid Vitamin E. I think some also say avoid Vitamin C,
>
> I can't see that they would make any difference.  Vit E is supposed to be
> prescribed to plastic surgery patients, according to my textbook.  (Helps
> skin healing).

Attitude of plastics people to vitamin E varries widely.  Alas, no good
studies exist on bleeding in plastic surgery and vitamin E supplements. I'd
be surprised if it makes any difference for the person not taking coumadin.
Other plastics people are paranoid.  There isn't even good evidence one way
or the other on topical vitamin E, with studies going both ways.

 J Burn Care Rehabil 1986 Jul-Aug;7(4):309-12

Failure of topical steroids and vitamin E to reduce postoperative scar
formation following reconstructive surgery.

Jenkins M, Alexander JW, MacMillan BG, Waymack JP, Kopcha R.

Shriners Burns Institute, Cincinnati, OH 45219.

One hundred fifty-nine operative procedures for postburn contractures of
interdigital webs (96), the axilla (46), or the neck (17) were prospectively
randomized to be treated postoperatively for four months with a topical
steroid (Aristocort A), topical vitamin E, or the base cream carrier for
these drugs. The nature of the medication was blinded both to the patient
and to the evaluator. Patients were followed for one year. Observations were
made for range of motion, scar thickness, change in graft size, and ultimate
cosmetic appearance. No beneficial effect of either vitamin E or topical
steroid could be demonstrated. However, adverse reactions occurred in 16.4%
of patients receiving active drug, compared to 5.9% treated only with base
cream. Interestingly, the grafts initially contracted and subsequently grew
to be a size larger (about 20%) than the original graft by one year. It is
concluded that neither topical steroid nor topical vitamin E is effective in
reducing scar formation after grafting procedures for reconstruction for
postburn contractures.

Publication Types:
Clinical Trial
Randomized Controlled Trial

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Preparation for Surgery
Date: Thu, 18 Apr 2002 15:48:07 -0600
Message-ID: <a9nevr$hg0$1@slb4.atl.mindspring.net>

" MS" <ms@nospam.com> wrote in message
news:ubu0krj4i7q574@corp.supernews.com...
>
> "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com> wrote in message
> news:a9kjd1$jqj$1@slb4.atl.mindspring.net...
> > Sorry, but it depends on the NSAID. Aspirin will hurt your bleeding
> > time for 2 days; possibly longer if your platelet numbers or
> > production is abnormal. Aspirin is very different than other NSAIDs
> > because its action is irreversible in platelets-- a single aspirin
> > dose (more than 1/8th of a standard tablet) slightly disables every
> > platelet in your body permanently, so that somewhere around a quarter
> > of your platelets must be replaced before the body is back to normal
> > bleeding times (for which you need less than a quarter of your normal
> > platelets...). Many other NSAIDs (ibuprofen) only cause problems while
> > they're in your system-- less than a day. A few non-aspirin
> > salicylates (eg salsalate) and COX-2 inhibitors (Vioxx) have very
> > little effect on platelets and are perfectly fine to take when having
> > dental and other procedures.
>
> So, are you saying you disagree with the generally stated axiom to avoid
> NSAIDs entirely for two weeks before surgery, that that's not necessary.
> No aspirin a few days before, and no ibuprofen and others from the day
> before the surgery?


If your platelet count is normal, that should be all that is needed, yes.

And ONCE again, much depends on the surgury. If you've having facelift or
liposuction you may need to stop aspirin for a full week to get every last
platelet you have, working.

I don't think anybody can justify 2 weeks, for anything.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Preparation for Surgery
Date: Thu, 18 Apr 2002 19:14:25 -0600
Message-ID: <a9nr2s$oap$1@nntp9.atl.mindspring.net>

"Larry Preuss" <LPreuss@provide.net> wrote in message
news:180420022018085224%LPreuss@provide.net...
> In article <a9nevr$hg0$1@slb4.atl.mindspring.net>, "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
>
> > > So, are you saying you disagree with the generally stated axiom to
> > > avoid NSAIDs entirely for two weeks before surgery, that that's not
> > > necessary. No aspirin a few days before, and no ibuprofen and others
> > > from the day before the surgery?
> > >
> >
> >
> > If your platelet count is normal, that should be all that is needed, yes.
>
> I don't think this is entirely correct. ASA interferes with the
> function of platelets in clotting not by reducing their absolute number
> but by making them stick to each other less well. For this reason they
> do not hold together in forming the framework for a clot as well as
> normal and, as has been said before, one aspirin hit decreases the
> stickiness of a platelet for its entire life in the circulation.
>      Larry

COMMENT:

Yes, if you'd been reading, you'd find I never said otherwise.

Still, to get rid of the aspirin platelet effect you need to make 50,000 to
100,000 new platelets per mm^3.  How long it takes you to do that is the
question. Generally you can figure that somebody with a platelet count of
400,000 is making them twice as fast as someone at 200,000 and so on (since
everybody loses about the same fraction every day).  That doesn't hold for
people who have the low count because of consumption (bleeding or some other
problem), so you can't always say that people with low counts are making
them slowly. What you can say is that people with nice high counts are
making them fast, and will recover normal bleeding times more quickly after
an aspirin dose.

Clear now?

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Preparation for Surgery
Date: Thu, 18 Apr 2002 16:19:57 -0600
Message-ID: <a9ngrh$3rb$1@slb4.atl.mindspring.net>

"Michael Roose" <somewhatusfultrainer@hotmail.com> wrote in message
news:njaubuc2616bjrse3fu27ov50t9bg734ba@4ax.com...
> On Wed, 17 Apr 2002 13:45:15 -0600, "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
> | a single aspirin dose (more than 1/8th of a
> |standard tablet) slightly disables every platelet in your body permanently,
> |so that somewhere around a quarter of your platelets must be replaced before
> |the body is back to normal bleeding times (for which you need less than a
> |quarter of your normal platelets...).
>
> How is it that they are only "slightly" disabled.  Isn't this an
> either/or proposition?

Not at all, and that's the point. Each platelet still works, just not quite
as well.


> Whether it is or isn't, can you assume that large doses of aspirin
> over continuous periods of time would create a permanent "bleed-out"
> condition?

No. The amount of aspirin over 40 mg a day has almost no (not quite none,
but almost) additional effect on platelets. Larger doses of aspirin are
irritating to the stomach, but how well you stand up to that is individual.
Many people with rheumatoid arthritis in the old days took 20 aspirin a day
for 20 years without harm. Of course, not everyone can get away with that.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: alt.support.sinusitis,sci.med
Subject: Re: Preparation for Surgery
Date: Thu, 18 Apr 2002 19:09:05 -0600
Message-ID: <a9nqqq$53u$1@slb1.atl.mindspring.net>

"Larry Preuss" <LPreuss@provide.net> wrote in message
news:180420022021206731%LPreuss@provide.net...
> In article <a9ngrh$3rb$1@slb4.atl.mindspring.net>, "Steve Harris"
> <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
> > Many people with rheumatoid arthritis in the old days took 20 aspirin
> > a day for 20 years without harm. Of course, not everyone can get away
> > with that.
> >
> > SBH
>
> In those old days one of the ways used to judge the dose of aspirin
> that could be given for the arthritis was to slowly increase the dose
> until the ringing (buzzing?) in the ears became really bothersome.
>      Larry


Yep. It worked, too.

SBH