Stopping Warfarin Therapy is Unnecessary for Hand Surgery

Abstract

Interruption of appropriate therapeutic warfarin therapy imposes a risk of morbidity and mortality on the patient. Strategies to reduce the risks of interruption impose relatively large costs in terms of prolonged hospital stay, medication and coagulation monitoring. We report a series of 47 consecutive surgical episodes on the hands of 39 patients without interruption of therapeutic warfarin anticoagulation and with an INR of between 1.3 and 2.9. There was no difficulty with intraoperative haemostasis. Two patients had minor bleeding-related complications with no long-term sequelae. The authors conclude that interruption to warfarin therapy is unnecessary if the INR is less than 3.0 and therefore inappropriate for therapeutically anticoagulated patients undergoing hand surgery.

Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice

“…What has become apparent, however, is that the risk of bleeding is dependent on the nature of the procedure being performed [23]. Whilst warfarin need not be discontinued for elective hand surgery, most authors conclude that major surgery can only be performed if the INR is < 1.5 [24][25][26]. About 35% of the respondents in our study would, however, consider hemiarthroplasty with an INR > 1.5 and < 2.0.…”

Management Guidelines in Patients on Antithrombotic Therapy Subjected to Surgical Intervention

“…ACCP guidelines consider that it is safe to perform dental procedures in the presence of a therapeutic INR (1B) protecting against hemostasis by means of fibrinolysis inhibitors. Similar recom- (30). Considering patients on warfarin therapy (INR ranging between 2.0 and 3.0) normalization of the above-mentioned is observed after 4-5 days of discontinuation (31).…”

Discontinuation of Warfarin Is Unnecessary in Total Knee Arthroplasty

“…In another retrospective study of patients undergoing hand surgery, Wallace et al reported only two of 39 patients experienced minor bleeding-related complications, neither of whom required reoperation [34].…”

“…One study suggests there is a greater risk of DVT or PE when oral anticoagulation is manipulated compared with the background risk without anticoagulation [3]. In addition to the loss of DVT and PE protection caused by perioperative manipulation of the anticoagulation regimen the patient is normally on, restoring the patient to their preoperative steady-state INR is associated with added costs [34].…”