WARFARIN THERAPY

HIGH-RISK PATIENTS:
Afib associated with valvular disease
Mechanical valve in the mitral position
Mechanical valve and prior thromboembolic event

LOW-RISK PATIENTS:
DVT
Uncomplicated or paroxysmal Afib
Bioprosthetic valve
Mechanical valve in aortic position

HIGH-RISK PROCEDURES:
Polypectomy
Biliary Sphincterotomy
Pneumatic or Bougie dilation
PEG
ERCP/EUS with FNA
Laser ablation and coagulation
Treatment of varices

Stop warfarin 3-5 days before;
Consider heparin while INR below therapeutic

Stop warfarin 3-5 days before
Restart warfarin after procedure

LOW RISK PROCEDURES:
Diagnostic: EGD/Cscope/Flex Sig ± Biopsy
ERCP without Sphincterotomy
Biliary/Pancreatic stent without endoscopic sphincterotomy
EUS without FNA
Enteroscopy

No change in anticoagulation; Elective procedures should be delayed while INR is supratherapeutic