Endoscopy

[Ebenezeer1938]

Having procedure Monday 17th. I have PAF and have to stop warfarin today. Concerned about the level of protection if I go into AF until I resume warfarin next week. Ebenezeer38.

[Hidden]

This seems to be standard advice from many gastroenterologists. However there is a small risk from stopping warfarin for 5 days even for paroxysmal AF. I can see you have had a previous ablation.

You can bridge the gap with Fragmin, but if the endoscopy is not urgent, is this a good time to think about switching from warfarin to a DOAC like Apixaban? This has a much shorter half life than warfarin.

[Hidden]

Prior to my knee replacement I had to stop warfarin for a week before surgery. Immediately after surgery I received 2 injections of Fragmin, then resumed my normal warfarin dose that evening. From the day I stopped warfarin till the day I got back into INR range was 29 days. No problems.

[BobD Volunteer]

When I had my gastroscopy earlier in the year I asked the doctor and he told me nothing he did would cause me any problems and I did not have to stop warfarin. This despite the pre op letter telling me to phone the hospital if I was on anticoagulants. I suggest that you check in person. (He did take two or three biopsies with zero problem .)

[Hidden]

youtube.com/watch?v=CwX7xs_...(Not working as expected?)

no evidence to show that there is a greater risk whilst in AF

[ILowe]

This is a good recent summary.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

ncbi.nlm.nih.gov/pmc/articl...

See Figure 2.

However, I have seen a trend over the years to avoid stopping anticoagulants, but not all hospitals are following the trend. I have also seen them being really fussy about the INR value being back to normal before releasing someone from hospital, or stopping the Heparin jabs. For instance, the requirement that the INR be in range on three successive days, instead of one day. For instance, in a friend whose target INR was 3.5, and range 3-4, they refused to stop the Heparin jabs until he was over 3.5, instead of over 3.

You can expect caution, but, in your favour, is that opinion about the balance of risk of doing the procedure without stopping versus the risk of stopping, is swinging towards continuing anticoagulation if possible.