The Guidelines and Protocols Advisory Committee’s (GPAC) guideline provides recommendations for the management of warfarin therapy in adults aged = 19 years who require invasive procedures and surgery. It is available to physicians across BC via www.BCGuidelines.ca [10].

Key recommendations
•    It is necessary to discontinue warfarin prior to invasive procedures for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without biopsy, and percutaneous venous access.
•    For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization of the international normalized ratio (INR).
•    For urgent procedures, use of prothrombin complex concentrate is highly effective in rapidly reversing warfarin anticoagulant activity and has a duration of action of approximately 6 hours.
•    The use of bridging heparin therapy is dependent on the risk of thrombosis.
•    Discuss the risk of bleeding with the surgeon and anesthesiologist to determine optimal timing for resuming warfarin and bridging heparin therapy after surgery.