ACC Releases Afib Treatment Interruption Guidelines
Recommendations for patients on warfarin or another vitamin K antagonist include:

1. Continuing therapy with warfarin or another vitamin K antagonist without interruption in patients undergoing procedures with "no clinically important or low bleed risk and no patient-related factor(s) that increase the risk of bleeding."
2. Temporarily interrupting treatment in patients undergoing procedures with intermediate or high bleed risk or patients undergoing procedures with uncertain bleed risk and the presence of patient-related factor(s) that increase the risk of bleeding.
3. Interruption of treatment should be considered based on clinical judgment and consultation with proceduralists in patients with low bleed risk and the presence of factors that increase bleeding risk or patients undergoing procedures with uncertain bleeding risk with no patient-related factors that increase bleeding risk.

Recommendations on how vitamin K antagonists should be interrupted include:

1. Discontinuation of therapy three to four days prior to the procedure in patients with INRs of 1.5-1.9 if a normal INR is desired.
2. Discontinuation of therapy five days prior to the procedure in patients with an INR between 2.0 and 3.0 if a normal INR is desired.
3. Discontinuation of therapy at least five days prior to the procedure in patients with INRs of greater than 3.0.

http://www.medpagetoday.com/cardiology/arrhythmias/62420
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