Should anticoagulation be stopped in patients requiring surgical interventions? If yes, when?
A. We do not have good data regarding peri-procedural anticoagulation. Most patients can undergo dental procedures, joint and soft tissue injections, arthrocentesis, cataract surgery and upper endoscopy or colonoscopy (with or without biopsy) without changing their anticoagulation regimen. However the risk of a thromboembolic event and/or postoperative bleeding needs to be considered on an individual basis. For example, it would be reasonable to continue anticoagulation regimen in a patient with a mechanical mitral valve who will be having a minor surgical procedure since the risk of thromboembolic stroke overshadows the risk of major hemorrhage. For other invasive procedures carrying high risk of postoperative bleeding, oral anticoagulation needs to be withheld and the decision of whether aggressive treatment of perioperative bridging with intravenous heparin or subcutaneous LMWH should be individualized.
