SAMMC Departments: Coumadin - Elective Procedures and Surgery

Patient Information

Coumadin

Recommendations and Management of Elective Procedures and Surgery in Coumadin Recipients

Coumadin® patients may occasionally face additional surgery or invasive procedures at some point in their future life. However, it is potentially dangerous to undergo some elective operations while anticoagulated. For instance, brain or eye surgery can be dangerous while on blood thinners. Even less serious operations, such as prostate or joint replacement surgery, can be associated with serious bleeding in a fully anticoagulated patient. It is good advice to always inform your physician or surgeon that you are taking Coumadin®. Before any planned procedure, an INR should be checked to see what level of anticoagulation exists in your blood at that time. You should conference with your surgeon and ask whether Coumadin® should be temporarily stopped around the time of the upcoming operation. In most situations, a temporary stoppage of Coumadin® is all that will be needed. In some situations, anticoagulation should not be completely stopped. Some heart valve patients should remain on blood thinners (except during the actual elective surgery itself). In these patients, the Coumadin® is usually stopped several days before surgery, and substituted with intravenous heparin. Heparin cannot be absorbed orally, and must be given by either continuous intravenous infusion or by intermittent shots under the skin (subcutaneous). Although this form of anticoagulant therapy is much less convenient, heparin has a short life span in the body and will be cleared rapidly after stopping therapy. Thus, it is possible to stop Coumadin® for several days while continuing to thin the blood with heparin up until the elective operation is performed. After the Coumadin® effect has worn off (usually about 3 days), the heparin can be stopped shortly before the start of the elective operation. The procedure can be performed without any anticoagulation on board, and then the heparin restarted if necessary after completion of the surgery. Coumadin® is then restarted when the patient can take oral medications. When the Coumadin® effect has been obtained again, heparin infusions are stopped. Although all of this sounds complicated, it is not difficult to accomplish. The safety of operating without any anticoagulation on board must be weighed against the inconvenience(s) of these additional steps. If you are facing an elective surgical procedures in the near future, make sure your surgeon knows you are taking Coumadin® . He/she can advise you whether you are at risk for bleeding if Coumadin® is still in effect at the time of your surgery. If so, ask your surgeon, cardiologist, or treating physician about temporary stoppage of Coumadin® and/or the need for heparin in preparation for your operation.

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