Warfarin and cardiac catherization

[kakamegamama]

Hi all. Please know that I am NOT asking for medical advice. I've researched, and have a very tired brain at this moment. Can anyone tell me the standard of practice for how long a patient has to be off of warfarin before a cardiac catheterization. Also, any idea of increased complication risk to that procedure for the patient? I did find one article that addressed how complications are related to the INR, but nothing yet as to timing of warfarin stoppage, or relationship to length of time on warfarin and complication risk. My husband has been on warfarin about 5 years, and is facing a cardiac cath within the next few weeks (We think. We're still awaiting confirmation.)

And, if you prefer--please send me in the right direction and I'll be happy to follow a link and read for myself....at this point I just can't seem to get my brain to get me there on my own and I'm at a loss.....

Thanks!

[Rose_Queen, BSN, MSN, RN]

This is something you need to discuss with your husband's cardiologist. He/She knows best what his plan of care should be.

[kakamegamama]

This is something you need to discuss with your husband's cardiologist. He/She knows best what his plan of care should be.

Of course! I am trying to get as much info as possible in order to answer questions from our employer and colleagues on the other side of the world. Thus far, physician response has been not forthcoming. I know decisions specific to my husband will be made. I am trying to find standards of practice.

[MunoRN, RN]

In the US, the (conservative) practice recommendation is here: http://content.onlinejacc.org/article.aspx?articleid=1212373

It does recommend stopping warfarin prior to an elective cath, although that's certainly not the standard of practice since many physicians only avoid supratherapeutic INRs. In emergent cases, we obviously don't care if the patient is on coumadin, and we actually give large amounts of anticoagulants, usually heparin along with either bivalarudin or integrilin, and they've often had a loading dose of plavix or effient prior to the cath.

[kakamegamama]

In the US, the (conservative) practice recommendation is here: http://content.onlinejacc.org/article.aspx?articleid=1212373

It does recommend stopping warfarin prior to an elective cath, although that's certainly not the standard of practice since many physicians only avoid supratherapeutic INRs. In emergent cases, we obviously don't care if the patient is on coumadin, and we actually give large amounts of anticoagulants, usually heparin along with either bivalarudin or integrilin, and they've often had a loading dose of plavix or effient prior to the cath.

Thank you!

[dianah, ASN]

Article in Cath Lab Digest:

http://www.cathlabdigest.com/articles/When-Is-It-Safe-Cath-Someone-Coumadin

[kakamegamama]

Article in Cath Lab Digest:

http://www.cathlabdigest.com/articles/When-Is-It-Safe-Cath-Someone-Coumadin

Thank you! This is actually the article I read before brain drain, but I need to re-read.

[kakamegamama]

Warfarin is being stopped today/tomorrow. His cath is next Tuesday and he was told that the doctor wants him off for at least 5 days. Thanks again!