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 [9].
Key recommendations
• 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.
Links
[1] https://bcmj.org/cover/march-2016
[2] https://bcmj.org/node/95
[3] https://bcmj.org/sites/default/files/BCMJ_Vol58_No2_pulsimeter_1_2.pdf
[4] https://bcmj.org/print/news/gpac-guidelines-warfarin-therapy%E2%80%94management-during-invasive-procedures-and-surgery
[5] https://bcmj.org/printmail/news/gpac-guidelines-warfarin-therapy%E2%80%94management-during-invasive-procedures-and-surgery
[6] http://www.facebook.com/share.php?u=https://bcmj.org/print/news/gpac-guidelines-warfarin-therapy%E2%80%94management-during-invasive-procedures-and-surgery
[7] https://twitter.com/intent/tweet?text=GPAC guidelines: Warfarin Therapy—Management During Invasive Procedures and Surgery&url=https://bcmj.org/print/news/gpac-guidelines-warfarin-therapy%E2%80%94management-during-invasive-procedures-and-surgery&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://bcmj.org/javascript%3A%3B
[9] http://www.BCGuidelines.ca
[10] https://bcmj.org/modal_forms/nojs/webform/176
[11] https://bcmj.org/%3Finline%3Dtrue%23citationpop