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CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 138-140

Anticoagulation in minor therapeutic procedures: A dilemma?


Department of Medicine, ASCOMS and Hospital, Sidhra, Jammu, Jammu and Kashmir, India

Correspondence Address:
Sanjay Bhat
Department of Medicine, ASCOMS & Hospital, Sidhra, Jammu - 180 017, J&K
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.117922

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The patient on chronic anticoagulation (warfarin and aspirin) underwent therapeutic pleural paracentesis for massive tubercular pleural effusion, developed thromboembolic stroke within 48 hours after the procedure, after stopping anticoagulants for one day prior to the pleural paracentesis. To examine the rationale and problems associated with preoperative/pre-procedure anticoagulation withdrawl. Review of the medical literature. When anticoagulation(warfarin) is stopped prior to any minor therapeutic procedure where the patient is at increased risk for thromboembolism, the bleeding risk is extremely low and can be easily managed.In view of narrow therapeutic index and the drug interaction between warfarin with anti-tubercular drugs like rifampicin, risk of thromboembolism significantly increases further. Warfarin should not be discontinued prior to any minor therapeutic paracentesis/procedure because the risk of thromboembolism over weighs the risk of bleeding.


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