Withdrawal of warfarin prior to a surgical procedure: Time to follow the guidelines?

Sergey E. Akopov, Shuichi Suzuki, Andre Fredieu, Chelsea S. Kidwell, Jeffrey L. Saver, Stanley N. Cohen

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background and Objective: Patients with cardiogenic sources of embolism may be at increased risk of cerebral infarction when anticoagulation therapy is suspended for surgical procedures. The purpose of this study was to determine frequency of cardioembolic cerebral infarction during periprocedural warfarin withdrawal. Methods: Retrospective analysis of prospective cerebral infarction registry data from two tertiary medical centers. Results: Over a 12-month period, 14 cases of cardioembolic cerebral infarction occurring during the period of warfarin withdrawal for a medical procedure were observed, accounting for 7.1% of the 197 cardioembolic cerebral infarctions encountered. Across all patients, cerebral infarctions developed an average of 5.4 days after the last dose of warfarin (range 3-8). Among the 14 patients (8 males and 6 females) with warfarin cessation-related infarcts, age ranged from 54 to 91 years. Each had been on chronic anticoagulation with warfarin for more than 1 year. Retrospective analysis suggested that all these cerebral infarctions had been potentially preventable. In each case, either the planned procedure did not require discontinuation of warfarin or, when withdrawal was required, no bridging, parenteral anticoagulation was provided to lessen the risk during the warfarin-free period. Conclusion: Patients at high risk of cardioembolic cerebral infarction may benefit from more intensive management strategies to reduce cerebral infarction risk during periprocedural periods.

Original languageEnglish (US)
Pages (from-to)337-342
Number of pages6
JournalCerebrovascular Diseases
Issue number5
StatePublished - Apr 2005


  • Atrial fibrillation
  • Cardioembolic stroke
  • Cerebrovascular disease
  • Warfarin

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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