| A: The
risk of withdrawing anticoagulation therapy with coumadin, aspirin or any other
antiplatlet therapy must be weighed against the relative risks and benefits. The original
indication for the blood thinner and the risks associated with its withdrawal (blood
clots, unstable angina, heart attack, stroke etc.) must be weighed against the strength of
the indication for the endoscopic procedure. Sometimes colonoscopy can be performed without
stopping the anticoagulation or antiplatelet therapy at all. Another alternative is for
the physician to prescribe Heparin or Lovenox injection therapy pre and postoperatively to
replace coumadin in the high risk patient. In the final analysis, each physician must help
his patient to decide on an appropriate course of action. As with so many therapeutic
decisions in medicine there is no single right answer. A2:
The duration of time for discontinuation of coumadin therapy prior to
an endoscopic procedure depends on several factors. The level of the protime inr blood
test results and the preoperative anticoagulation treatment goals will determine how many
days it will take for the coumadin to get out of the system. The doctor can hurry this
process by administering Vitamin K, or in very urgent circumstances by transfusing fresh
frozen plasma if active bleeding is suspected. There are, however, additional risks associated with these approaches. If
for example, the usual PT inr blood test is 2.0 then withholding the coumadin for 3-4 days
may be sufficient. If the PT inr result was 3.0 then a longer period of avoidance
may be required. Individual circumstances however may differ and the physician can
always check the protime preoperatively for a definitive confirmation. This may be
necessary if a biopsy or removal of a polyp is being considered. |