In addition to predisposing a patient to hypercoaguability and thrombosis, cancers may also cause an antithetical bleeding diathesis through primary fibrinolysis. This paraneoplastic pathology has been documented and studied in prostate cancer patients for nearly a century but is underrecognized as a possible complication of surgery. We report a case of primary fibrinolysis after elective ectropion repair in a patient with prostate cancer. Here paraneoplastic fibrinolysis produced a delayed postoperative hemorrhage requiring specialized therapies, including hospitalization for transfusions of fresh frozen plasma and inhibitors of fibrinolysis. Even in the case of an ambulatory and stable cancer patient, awareness of this complication and its management can help guide surgical decision-making and improve outcomes and follow-up care.