as per our guideline.
Letter to the Editor
Editor, – Thank you for the informative and detailed article on antiplatelets, anticoagulants and elective surgery (Aust Prescr 2011;34:139-43).
The authors noted that patients requiring a biopsy during an elective endoscopy should follow the recommendations for those having general surgery. However, patients who do not require a biopsy during an endoscopy should follow the recommendations for dental, dermatological and ophthalmological procedures. In practice, it is usually not known before a colonoscopy whether or not a polypectomy will be required, and some gastroenterologists perform biopsies on most or all patients having elective endoscopies. I therefore presume the take-home message is to treat most patients according to the recommendations applying to general surgery.
I was also interested to read that warfarin could be resumed on the evening of the procedure, but at the usual maintenance dose with no loading dose. Why is a loading dose not advised? Having a patient at a sub-therapeutic INR level for a relatively prolonged period after a procedure can complicate the logistics of their care, particularly if they are unable or unwilling to self-administer low molecular weight heparin, and live in a rural area.