Management of anticoagulants before and after endoscopy: BLEEDING RISKS
Most bleeding that occurs after an endoscopic procedure is immediate, and results from inadequate hemostasis. In more than 80% of cases of bleeding, the diagnosis is made within 48 h of the procedure. Most of the remainder of bleeding episodes occur within the next 10 days.
Some studies have found that severe acute bleeding from peptic ulcer disease can safely be managed endoscopically even in patients who take anticoagulants. Nevertheless, surgical studies have shown that the restoration of intravenous heparin therapy immediately after surgery increases the absolute rate of major hemorrhage by approximately 3%, and that 3% of these episodes are fatal or lead to long term disability.
After warfarin is discontinued, the INR can be expected to fall to 1.5 in almost all patients within roughly four days if the INR starts at 2.0 to 3.0, or within five days if the INR starts at 2.5 to 3.5. Once the INR reaches 1.5, surgical or endoscopic procedures can be performed without an increased risk of bleeding.
The INR should be measured on the day before endoscopy. If the INR is higher than 1.7, a small dose of vitamin K (1 mg subcutaneously) should be administered. If the INR is between 1.7 and 2.0 immediately before endoscopy, fresh frozen plasma may be given.
After warfarin therapy is resumed, approximately three days are required for the INR to reach 2.0. Therefore, warfarin therapy may be restarted on the night of the procedure provided that there is no obvious bleeding. Although there is biochemical evidence of a hypercoagulable state after cessation of oral anticoagulants, the existence of this phenomenon has not yet been confirmed clinically. Isn’t it nice to know you will soon be able to shop for your drugs online with the best pharmacy that will take great care of you? You do have this opportunity to buy birth control online here now that you have the best pharmacy waiting for your decision and offering cheapest drugs of best quality.