Do I need to hold anticoagulants (blood thinners), such as warfarin, aspirin, or clopidogrel, before getting a tattoo?

Management of Blood Thinners Before Getting a Tattoo

Blood thinners should be continued during tattoo procedures as the risk of thrombotic events from discontinuation outweighs the minimal bleeding risk that can be managed with local hemostatic measures.

Types of Blood Thinners and Their Management

Antiplatelet Medications

• Aspirin (75-100 mg daily): Continue without interruption for tattoo procedures 1
• Clopidogrel (75 mg daily): Continue without interruption 1
• Ticagrelor: Continue without interruption for minor procedures like tattoos 1

Anticoagulants

• Warfarin: Continue without interruption, but ensure INR is within therapeutic range (2.0-3.0) 2
• Direct Oral Anticoagulants (DOACs): Limited specific guidance for tattoos, but generally follow similar principles as other minor procedures

Risk Assessment and Decision-Making

High Thrombotic Risk Patients

Patients with the following conditions have higher thrombotic risk and should NOT discontinue anticoagulation:

• Recent coronary stent placement (especially within 12 months) 2, 1
• Mechanical heart valves 2
• Recent thromboembolism 2
• Atrial fibrillation with high CHADS2 score 2

Bleeding Risk Management

• The risk of significant bleeding during tattoo procedures in patients on anticoagulants is minimal 1, 3
• Any bleeding can typically be managed with local hemostatic measures:
  • Local pressure application
  • Absorbable hemostatic materials
  • Proper aftercare instructions

Special Considerations

For Patients on Dual Antiplatelet Therapy (DAPT)

• Higher bleeding risk compared to single antiplatelet therapy or warfarin alone 3
• Consider discussing with cardiologist if on DAPT (aspirin + clopidogrel) as this combination has shown increased bleeding risk in other minor procedures 3

For Patients on Triple Therapy

• Patients on triple therapy (anticoagulant + dual antiplatelet therapy) have significantly higher bleeding risk 4
• Consider temporary modification of regimen in consultation with cardiologist if possible

Important Caveats and Pitfalls

1. Never discontinue antiplatelet therapy after coronary stent placement without cardiologist approval - risk of stent thrombosis is life-threatening 1

2. Avoid NSAIDs for pain management after tattoo if already on aspirin, as this increases bleeding risk

3. Inform the tattoo artist about anticoagulation status so they can:

   • Use appropriate techniques to minimize trauma
   • Be prepared for potentially increased bleeding
   • Apply appropriate pressure after the procedure

4. Monitor for excessive bleeding after the procedure and seek medical attention if bleeding cannot be controlled with local measures

5. Consult with the prescribing physician before getting a tattoo, especially for patients with mechanical heart valves or recent stent placement 1

The evidence strongly supports continuing anticoagulation and antiplatelet therapy during minor procedures like tattoos, as the risk of thrombotic events from discontinuation far outweighs the minimal bleeding risk that can be effectively managed with local measures.