Harvard Heart Letter

Heart Beat: Heparin: a risky bridge over troubled waters?

Heart Beat

Heparin: a risky bridge over troubled waters?

Warfarin keeps blood from clotting where it shouldn't, such as in a chamber of the heart, on a heart valve, or inside unbroken blood vessels. Millions of people take warfarin (Coumadin, generic) to prevent a clot-caused stroke, pulmonary embolism, or deep-vein thrombosis.

It isn't yet clear how best to handle warfarin when a colonoscopy, oral surgery, cataract removal, or other minor surgery is needed. There are three options "" stay on warfarin (which increases the chances of bleeding during the procedure and for awhile afterward); stop taking warfarin for a few days before and after the procedure (which increases the chances of having a stroke or pulmonary embolism); or temporarily replace warfarin with heparin or another short-acting anticoagulant "bridge" (which increases the chances of bleeding).

Researchers with the Anticoagulation Consortium to Improve Outcomes Nationally (ACTION) study looked at how more than 1,000 people fared after temporarily stopping warfarin for outpatient surgery. The majority stopped all anticoagulation. In this group, just seven people (0.6%) developed a stroke, deep-vein thrombosis, or other clot-caused problem, and nine (0.8%) had a bleeding problem. In the small group of people who used a heparin bridge, none developed a clot but 13% had a bleeding problem.

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