High-risk procedures in patients with very high-risk conditions

If the procedure cannot be delayed, warfarin therapy should be discontinued four to five days before the procedure, and a heparin infusion should be administered as soon as the INR falls below 2.0. Heparin should be stopped 6 h before the procedure and restarted within 2 to 12 h after the procedure, in the absence of clinical bleeding. Warfarin therapy can generally be resumed on the night of the procedure. Heparin and warfarin should be given together until the INR has reached the target therapeutic range, usually within two or three days.

Drugs affecting platelet function

In the absence of a pre-existing bleeding disorder, endoscopic procedures may be performed on patients who take acetylsali-cylic acid or nonsteroidal anti-inflammatory drugs in standard doses. The data on other drugs that affect platelet function, such as ticlopidine or clopidogrel, are inadequate to make a recommendation. Nevertheless, for a high-risk procedure, the medication probably should be discontinued seven to 10 days beforehand. You can be sure your pharmacy offers cheap mircette only here delivering fast internationally.