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Blood thinners after surgery

Blood clots after surgery can cause serious problems. Chances are your doctor will prescribe a blood thinner (or anticoagulant) to help prevent them. You can also take these steps:

  • Wear compression stockings during the day. Take them off at night.
  • Do your daily joint exercises.
  • Go for daily walks.

Types of blood thinners

There are several kinds of blood thinners your doctor may prescribe:

Coumadin (warfarin)

Coumadin (or warfarin) comes in a pill. You should take it at about the same time each night. Your surgeon will tell you when it's safe to stop. A few tips:

  • Take the exact amount your doctor prescribed.
  • If you forget to take your evening dose, don't double your dose the next day.
  • You'll need to have blood tests once or twice a week to make sure you're taking the right amount. If you have home health services, the nurse will draw the blood and send it to the lab. Otherwise, you'll need to go to an outpatient medical lab or doctor's office.

Xarelto (rivaroxaban)

Xarelto (or rivaroxaban) is another pill your doctor may prescribe. It may be taken once or twice a day. A few tips:

  • Take the exact amount your doctor prescribed.
  • If you miss a dose, take the missed dose as soon as you remember. Don't take extra medication to make up for the missed dose.
  • Unlike other blood thinners, there is no blood testing needed for Xarelto. But your doctor may adjust your dose to make sure you get the best results.

Lovenox (enoxaparin)

Lovenox (or enoxaparin) comes in preloaded syringes. Each syringe contains a single dose. You inject it just under the skin in your stomach area. Your nurse will teach you and your coach how to give an injection before you leave the hospital. A few tips:

  • Gently pinch the skin between your fingers and place the needle in the fat layer just under the skin. Don't go deep into the muscle.
  • While still pinching the skin, push the plunger slowly until it's empty.
  • Avoid injecting yourself too close to your belly button or around existing scars or bruises. Your doctor may suggest alternating between different injection sites.
  • Avoid massaging the injection site.
  • Monitor injection sites for signs of infection, such as redness, pain, warmth or drainage. If any of these occur, contact your doctor right away.


Aspirin may be useful in preventing blood clots after joint replacement surgery. A few tips:

  • Take the exact amount your doctor prescribed.
  • If you miss a dose, take the missed dose as soon as you remember. Or skip that dose if it's almost time for your next scheduled dose. Don't take extra medication to make up for the missed dose.
  • Because aspirin has blood-thinning properties, you shouldn't use it when you're taking other blood thinners, such as Coumadin, Xarelto or Lovenox.
  • Use enteric-coated aspirin to help reduce stomach upset.

Taking blood thinners safely

Blood thinners are usually safe and effective if taken according to your doctor's directions. These tips can also help you use them safely:

  • Check with your doctor before taking nonsteroidal medications, vitamins or over-the-counter drugs that contain aspirin.
  • Be consistent in the amount of dark green, leafy vegetables you eat each day.
  • Avoid drinking alcohol.
  • Postpone any procedures that would cause bleeding, such as dental work or minor surgical procedures. If it's not possible to postpone the procedure, be sure the dentist or doctor knows you are taking blood thinners and that you've had a recent joint replacement.
  • Avoid any activities that may result in injury, including hobbies that use power tools or sharp instruments that could break the skin.

Signs and symptoms to watch for

If you fall, have a traumatic injury or experience any of the following symptoms while taking a blood thinner, call your surgeon right away:

  • Bleeding or oozing from your surgical wound.
  • Nosebleed.
  • Blood in your urine or stool.
  • Coughing or vomiting blood.
  • Excessive bleeding when brushing your teeth.
  • Spontaneous bruising (not caused by an injury).
  • Swelling in your thigh, calf or ankle that does not go away if you lie down with your feet elevated above your heart.
  • Pain and tenderness in the calf of either leg.
  • Dizziness, numbness or tingling.
  • Rapid or unusual heartbeat.
  • Vomiting, nausea or fever.

Also call your doctor right away if you accidentally take more than your prescribed dose, even if you don't have any symptoms.

If a blood clot travels to your lungs, it can be life-threatening. Call 911 right away if you experience:

  • Sudden chest pain.
  • Difficult or rapid breathing.
  • Shortness of breath.
  • Confusion.

Have a question about your medication?

Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with your surgeon or a member of our staff.

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