The Guidelines and Protocols Advisory Committee’s (GPAC) guideline provides recommendations for the management of warfarin therapy in adults aged = 19 years who require invasive procedures and surgery. It is available to physicians across BC via www.BCGuidelines.ca.
• It is necessary to discontinue warfarin prior to invasive procedures for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without biopsy, and percutaneous venous access.
• For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization of the international normalized ratio (INR).
• For urgent procedures, use of prothrombin complex concentrate is highly effective in rapidly reversing warfarin anticoagulant activity and has a duration of action of approximately 6 hours.
• The use of bridging heparin therapy is dependent on the risk of thrombosis.
• Discuss the risk of bleeding with the surgeon and anesthesiologist to determine optimal timing for resuming warfarin and bridging heparin therapy after surgery.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org