While vitamins and supplements are commonly used for health, they can significantly influence surgical outcomes. Discussing all supplements with your medical team is an important safety measure to ensure a smooth procedure and recovery, mitigating potential risks from anesthesia interactions or increased bleeding.
Supplements Increasing Bleeding Risk
Several vitamins and herbal supplements are known to interfere with the body’s natural blood clotting mechanisms, potentially increasing the risk of bleeding during and after surgery.
Vitamin E can inhibit vitamin K-dependent carboxylase, an enzyme crucial for activating blood clotting factors. This interference can lead to prolonged clotting times. Many healthcare providers recommend discontinuing Vitamin E at least seven days before surgery.
Fish oil, rich in omega-3 fatty acids, also affects blood clotting. While standard doses may not significantly thin the blood, high amounts can interfere with platelet function, potentially increasing bleeding time and reducing platelet aggregation.
Herbal supplements like garlic and ginkgo biloba also pose a bleeding risk. Garlic inhibits platelet aggregation, and ginkgo biloba can also increase bleeding risk, especially when combined with anticoagulant or antiplatelet medications. These supplements are often advised to be stopped at least one to two weeks before a procedure.
Ginger may inhibit platelet aggregation, increasing the risk of bleeding, particularly when used with antiplatelet medications. Ginseng, often taken for energy, also increases bleeding risk. A discontinuation period of about two weeks before surgery is frequently recommended for these herbal supplements.
Interactions with Anesthesia and Medications
Beyond bleeding risks, some supplements can interact negatively with anesthesia or other medications administered during surgery, potentially leading to complications.
St. John’s Wort, an herbal antidepressant, can influence the metabolism of many drugs. This can accelerate the breakdown of certain anesthetic agents, such as midazolam and alfentanil, leading to unpredictable anesthetic effects. It also possesses sedative properties that might prolong the effects of anesthesia.
Valerian root, used for sleep or anxiety, can interfere with anesthetic medications. Its tranquilizing properties can potentiate anesthesia’s sedative effects, potentially leading to delayed awakening or excessive perioperative sedation. Kava, another herbal supplement for anxiety, can similarly prolong anesthesia effects and cause excessive sedation. Kava also has the potential to affect blood pressure.
Ephedra, historically used as an appetite suppressant, can cause cardiovascular effects like high blood pressure and erratic heart rates. These effects are particularly dangerous during surgery due to potential interactions with anesthesia.
The Essential Pre-Surgery Conversation
A comprehensive discussion with the surgical and anesthesia teams about all supplements is important for safe surgical planning. This conversation allows medical professionals to provide personalized advice tailored to your specific health profile and the nature of your upcoming procedure. They can assess potential interactions between supplements and medications, helping to prevent complications.
Creating a complete list of all consumed items—vitamins, minerals, herbal supplements, over-the-counter drugs, and prescription medications—is crucial. Sharing this ensures your healthcare team has a full picture, enabling informed decisions and specific guidance on which supplements to stop, when to discontinue them, and when it is safe to restart them after surgery.