Withdrawal of Warfarin prior to a Surgical Procedure: Time to Follow the Guidelines?

Vol. 19, No. 5, 2005

Free Abstract Article (Fulltext) Article (PDF 137 KB)

Original Paper

Withdrawal of Warfarin prior to a Surgical Procedure: Time to Follow the Guidelines?
Sergey E. Akopov^a, Shuichi Suzuki^b, Andre Fredieu^b, Chelsea S. Kidwell^b, Jeffrey L. Saver^b, Stanley N. Cohen^a

^aDivision of Neurology, Cedars-Sinai Medical Center Los Angeles,
^bDepartment of Neurology, University of California, Los Angeles, Calif., USA

Address of Corresponding Author

Cerebrovasc Dis 2005;19:337-342 (DOI: 10.1159/000085027)

Key Words

Cerebrovascular disease
Atrial fibrillation
Warfarin
Cardioembolic stroke

Abstract

Background and Objective: Patients with cardiogenic sources of embolism may be at increased risk of cerebral infarction when anticoagulation therapy is suspended for surgical procedures. The purpose of this study was to determine frequency of cardioembolic cerebral infarction during periprocedural warfarin withdrawal. Methods: Retrospective analysis of prospective cerebral infarction registry data from two tertiary medical centers. Results: Over a 12-month period, 14 cases of cardioembolic cerebral infarction occurring during the period of warfarin withdrawal for a medical procedure were observed, accounting for 7.1% of the 197 cardioembolic cerebral infarctions encountered. Across all patients, cerebral infarctions developed an average of 5.4 days after the last dose of warfarin (range 3-8). Among the 14 patients (8 males and 6 females) with warfarin cessation-related infarcts, age ranged from 54 to 91 years. Each had been on chronic anticoagulation with warfarin for more than 1 year. Retrospective analysis suggested that all these cerebral infarctions had been potentially preventable. In each case, either the planned procedure did not require discontinuation of warfarin or, when withdrawal was required, no bridging, parenteral anticoagulation was provided to lessen the risk during the warfarin-free period. Conclusion: Patients at high risk of cardioembolic cerebral infarction may benefit from more intensive management strategies to reduce cerebral infarction risk during periprocedural periods.

Author Contacts

Stanley Cohen, MD
Division of Neurology, Stroke Service
Cedars Sinai Medical Center, 8631 West 3rd Street, Suite 1145E
Los Angeles, CA 90048 (USA)
Tel. +1 310 423 4873, Fax +1 310 423 4969, E-Mail Stanley.Cohen@cshs.org

Article Information

Received: July 19, 2004
Accepted: January 11, 2005
Published online: April 8, 2005
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 1, Number of References : 15

Medline Abstract (ID 15818034)

Download Citation

Cited In

This journal is part of the first subject package of the Karger

Journal Archive Collection

Information on packages (PDF)
Free sample issues

For non-native English speakers and international authors who would like assistance with their writing before submission, we suggest American Journal Experts for their scientific editing service.