Warfarin use before and after endoscopic procedures

Periprocedural interruption of warfarin therapy is not always necessary; see Overview of the use of antithrombotic therapy before and after endoscopic procedures in adults.

For all patients scheduled for a procedure with a low risk of bleeding, warfarin may be continuedASGE Standards of Practice Committee, 2016Chan, 2018Veitch, 2016. Check the international normalised ratio (INR) 5 to 7 days before endoscopy. If the INR is above the therapeutic range consult the specialist who prescribed the warfarin and the endoscopist performing the procedure.

For patients with a low risk of a thromboembolic event scheduled for a procedure with a high risk of bleeding, check the INR 5 to 7 days before the procedure. Consideration should be given to stopping warfarin. If warfarin is stopped, the last dose should be taken 3 to 5 days before the procedure and warfarin should be restarted within 24 hours after the procedure is completedASGE Standards of Practice Committee, 2016Chan, 2018.

For patients with a high risk of a thromboembolic event scheduled for a procedure with a high risk of bleeding, seek expert advice. If warfarin is stopped in these patients, bridging therapy may be indicatedASGE Standards of Practice Committee, 2016.

For more information about periprocedural use of warfarin, see the Cardiovascular guidelines.