Harvard Heart Letter

Ask the doctor: Is there a safe way to stop taking warfarin before surgery?

Q. I am a 79-year-old man with atrial fibrillation that is well controlled by Pacerone. I also take warfarin and aspirin to prevent stroke. I plan to have a tooth pulled next month and wonder if it is safe to go off the blood thinners. How are these medications handled when more serious surgery is needed?

A. Warfarin prolongs bleeding from a cut or wound, so most dentists ask their patients to stop taking it two or three days before having a tooth pulled. After the extraction, the medication is restarted once the bleeding has stopped. The procedure for more serious types of surgery usually involves stopping warfarin four to five days before the operation. For people with a low risk of stroke, stopping warfarin for a few days is safe.

That is the simplest case. A more complicated regimen is needed for individuals who have already had a stroke or who are at high risk for having one. This often involves a technique known as bridging — a daily injection of a different anticlotting drug, called low molecular weight heparin, during the time warfarin is stopped.

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