Please state the nature of the procedure, for which bridging therapy is required, the name of the responsible clinician and at which hospital location the procedure will be performed.
Note that referrals will almost always be from the specialist setting undertaking the procedure, but please see ‘Who not to refer’ for advice about minor procedures, too.
C.M & L.W 31-07-23
Who to refer:
Patients requiring surgery on long-term warfarin for:
- prosthetic heart valves;
- venous thromboembolism who require major elective surgery
Who not to refer:
Do not refer patients undergoing minor procdures for which anticoagulation does not require to be interrupted eg.
- endoscopy without biopsy or minimal/small biopsies (refer to British Society of Gastroenterology Guidelines)
- patients requiring routine dental extraction or minor dermatological procedures eg small skin biopsies, removal of minor skin lesions.
In such cases warfarin may be continued but the INR should be checked within 24 hours of the procedure.
How to refer:
Department of Haematology, RIE or SJH (SCI Gateway if from a GP).
Primary care investigations
Initial investigations – normally done by the specialist arranging the procedure:
- FBC
- INR
- U&Es
- Weight (Kg)
