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Dear Surgical Patients:

A number of nonprescription drugs can cause bleeding and bruising as well as a number have been suggested for its treatment. Certainly aspirin and aspirin-like drugs cause increased bleeding, and aspirin should be stopped for 12 to 14 days before surgery. Ibuprofen and ibuprofen-like drugs also cause bleeding, and should be stopped for at least 1 week before surgery. Tylenol is fine before surgery and may be taken right up until the day of surgery. Following surgery we recommend that aspirin and ibuprofen be avoided for at least 5 days.

A number of nonprescription drugs have been recommended for bruising following surgery. We have tried many of these, and feel that the most efficacious seem to be Arnica Montana and Vitamin C. Vitamin C should be taken in large doses, approximately 2 or 3 grams, beginning the day before surgery and for several days after surgery. Arnica Montana can be purchased at health food stores, and the size of pills may vary, so directions for use in bruising should be followed. I advocate people start the pills the day before surgery and continue for several days after surgery.

Other agents which may be used include bromelin, which may be purchased at health food stores, and the directions on strength should be followed. I have been unimpressed with bromelin, but some other physicians and patients have recommended it. Vitamin E oil is useful on incisions beginning several weeks after surgery, and incisions should be kept out of the sun and sunscreen used in exposure areas for many months following surgery to avoid increased scarring and pigmentary reaction. Massaging vitamin E oil into scars is useful, but taking large doses of vitamin E prior to surgery may in fact increase bleeding, and only standard doses should be taken prior to surgery.

While I do not necessarily recommend that all patients take these anti-bruising measures, I do believe they are helpful in reducing bruising and swelling in many cases, and so far have not observed untoward side effects from their use.

Sincerely yours,
Chun Cheng Lin Yang, M.D., M.Sc.
Costa Rica Oculoplastics Inc.