Warfarin
Warfarin management requires a procedure-specific assessment of bleeding and thromboembolic risk.
Interruption and bridging
When warfarin interruption is required, CHEST 2022 suggests stopping warfarin at least 5 days before the procedure. Bridging is not routine and CHEST recommends/suggests against heparin bridging in several common indications, including atrial fibrillation and many patients with mechanical valves or VTE. Procedure-specific and thromboembolic risk assessment remains essential.
The indication, INR and procedure-specific bleeding risk inform the individual plan. Very high thrombotic-risk situations require specialist planning; CHEST and cardiovascular guidance should be interpreted in their respective clinical contexts. Planning includes the timing of restarting treatment as well as any interruption.