posted by LBenz_PT 9d ago

Will peptides interfere with my anesthesia or post-op medications?

Had a conversation with one of our surgical liaisons last week that I haven't been able to shake. Patient six days out from an ACL graft wants to start BPC-157 for the tendon healing piece but she's still on a DOAC for a prior clotting history. I know BPC-157 and TB-500 both push angiogenesis, and I can't find anything on whether that creates any real interaction risk with anticoagulants. Anesthesia itself I'm less worried about since she's a week out, but has anyone here actually seen a post-op patient run into trouble combining peptides with blood thinners, NSAIDs, or opioids? Not looking for guesses, looking for what people have actually observed.

Humanize the rehab process.

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MDrake_DPTBaltimore, Maryland6 points9d ago

The honest answer is nobody has formally studied this. BPC-157 has shown effects on the nitric oxide pathway and dopamine signaling in animal models, so there's at least a plausible mechanism for interaction with drugs touching those systems, but that's mechanistic reasoning, not documented interaction data. I'd treat the anticoagulant question as genuinely unknown rather than safe.

Neuro rehab nerd, clinical educator.

ELee_DPTMaryland, Washington D.C. metro area9 points9d ago

Unknown isn't dangerous, it's just unknown.

Lost my career to a knee. Now I fix them.

DrReleford_DPMLos Angeles, CA5 points8d ago

From the vascular side this is exactly the conversation I want happening before anyone touches a peptide. Angiogenesis promoting compounds stacked on top of an anticoagulant in a patient with any clotting history is the kind of combination I'd want the surgeon aware of directly, not just the PT. Get vascular status checked, don't guess.

Save limbs. Save lives.

NOuta_ResearchKenya4 points8d ago

Is there any published mechanism data on GHK-Cu and NSAIDs specifically?

Science is only useful if people can use it.

GKatz_ATCMid-Atlantic region5 points8d ago

Anesthesia clearance is the easier part honestly, most agents are gone from the system in 24 to 72 hours so starting peptides a few days post op sidesteps that entirely. The medication stack during the acute window is the bigger variable, especially with athletes on NSAIDs and opioids simultaneously. I always push the timing question to the surgical team directly.

Twenty plus years keeping athletes on the ice.

LBenz_PTLouisville, Kentucky3 points8d ago

So the DOAC question stays genuinely open then, no shortcuts around it.

Humanize the rehab process.

CKmiec_LALos Angeles, California3 points8d ago

Wild how little data exists for something used this widely.

Technique first, load second.

MDrake_DPTBaltimore, Maryland1 points7d ago

Worth separating the two concerns since they get lumped together constantly. Anesthesia exposure is a short window problem, the drugs clear fast and if you're not introducing peptides until several days out you've mostly avoided any overlap. The medication interaction question is different because you might be on opioids, NSAIDs, and an anticoagulant simultaneously for weeks. Nobody has mapped how BPC-157's effect on nitric oxide signaling interacts with any of that at a clinical level. I tell patients that exact gap, then let them decide with their surgeon in the loop.

Neuro rehab nerd, clinical educator.

TSalamanca_CTNew Haven, Connecticut6 points7d ago

This is why I always tell clients to loop their surgeon in first.

Motivation is the missing rep.

ELee_DPTMaryland, Washington D.C. metro area3 points7d ago

Most surgeons I've worked with have never even heard of these compounds.

Lost my career to a knee. Now I fix them.

LBenz_PTLouisville, Kentucky2 points7d ago

That's the real barrier, not the biology.

Humanize the rehab process.

DrReleford_DPMLos Angeles, CA2 points7d ago

If a patient has any clotting disorder history I want a direct line between the surgeon and whoever is recommending peptides before anything starts, full stop. Angiogenesis and anticoagulation sitting on top of each other with zero data is not a place I want a patient improvising alone. Ask the vascular question before the tendon question.

Save limbs. Save lives.

BCole_FSTHouston, Texas6 points7d ago

Getting everyone talking to each other is half the battle.

Move well first. Everything else follows.

NOuta_ResearchKenya3 points7d ago

Would love to see even a small retrospective case series on this eventually.

Science is only useful if people can use it.

GKatz_ATCMid-Atlantic region3 points7d ago

Never seen it cause a problem in our athletes so far.

Twenty plus years keeping athletes on the ice.

LBenz_PTLouisville, Kentucky3 points7d ago

Appreciate the input, good to know where the real gaps are.

Humanize the rehab process.