What to do with warfarin when a procedure is scheduled has always been a topic of much debate… Some favor stopping anticoagulation altogether, others think that it should continue without interruption. As with just about everything else involving warfarin, the decision should be made based on an individual patient’s risks and benefits and the procedure being performed.
The following is a list of VERY general guidelines for some common outpatient procedures. Again, what to do with warfarin should ALWAYS be discussed with your providers.
General recommendations are often too general, but can be useful and guide us in the right direction. ALL decisions regarding warfarin dosing should be made together with the patient, anticoagulation provider and the doctor performing the procedure—everyone needs to be in agreement and on the same page.
Based on nationally published guidelines, you usually continue warfarin without stopping
Dentist: cleaning, filing, cap, crown, root canal and even extraction
To put it bluntly, you aren’t likely to bleed to death from your mouth. While none of us wants to bleed while the dentist is working on us, when you take warfarin, your risk of complications if you stop warfarin is generally much greater than your risk of significant bleeding following a dental procedure. The dentist can apply pressure, gauze and medicines to minimize bleeding during and after the procedure. There is even a mouthwash that can be made to stop bleeding in your mouth without getting into your bloodstream and causing clots elsewhere (tranexamic acid).
Same here—the skin is easy to bandage, stitch and apply medication to. Rarely does one need to stop warfarin for a routine biopsy or excision.
This is an eye surgery that carries little bleeding risk so warfarin is usually continued. (Retinal surgery for glaucoma is NOT in this category)
More Involved Procedures:
This is where it starts to get tricky and YOUR reason for taking warfarin and the procedure being performed have to be evaluated on a case-by-case basis
Several scenarios each with increasing levels of bleeding risk
Virtual—you swallow a small camera that transmits the pictures of your GI tract
Routine screening—usually done every 10 years or so because there is no known history of problems and therefore no expected biopsies
Multiple planned biopsies
Cardioversion—generally must be anticoagulated several weeks prior to and following this procedure
Pacemaker or defibrillator placement (or battery change)—usually continue warfarin and expect bruising
Ablation—a provider and patient specific plan is usually formulated
These usually require significant coordination between providers and interruption of warfarin with LMWH (low-molecular weight heparin/enoxaparin) bridging
Cardiothoracic (angiogram, stent, CABG, etc)
Epidural or Anesthesia
Urology (prostate biopsy, lithotripsy, cystoscopy)