Management of Patients Receiving Warfarin during Invasive Procedures and the Adverse Effects of Warfarin

Aim: The aim of this study was to assess the frequency and characteristics of complications in patients on anticoagulant therapy who were to undergo invasive procedure. Methods and Results: We sent a questionnaire to 2758 doctors who were on the mailing list of the Japanese Society of Cardiac Pacing and Electrophysiology in August 2004. We received 614 questionnaires (response rate, 22.3%). Out of the 614 doctors, 19 (3.1%) reported that their patients had embolic events upon the interruption of warfarin therapy during dental extraction. In patients undergoing invasive procedures such as surgery, endoscopy, pacemaker implantation, and catheterization, 168 (27.4%) of the 614 doctors reported embolic events after the interruption of warfarin therapy. Further, 255 (41.5%) of the 614 doctors reported bleeding episodes when warfarin therapy was continued during the invasive procedures. Conclusion: Several complications of different types were reported to occur in patients receiving warfarin therapy who underwent elective invasive procedures, regardless of whether warfarin administration was interrupted or continued at the time of the invasive procedure. Therefore, it is necessary to make careful decisions about the management of patients on warfarin therapy who will be undergoing invasive procedures.