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What is Warfarin to be stopped____________ days before surgery? and explain in detail?
Ans. is 'b' i.e., 4 to 5 days Warfarin may increase peri- operative bleeding, except for minor procedures such as cataract surgery without bulbar blocks. No consensus exists on the optimal perioperative management of patients receiving warfarin. The usual recommendation is to withhold warfarin staing 4 to 5 days preoperatively (if the INR is between 2.0 and 3.0) to allow the INR to decrease to less than 1.5, which is a level considered safe for surgical procedures and neuraxial blockade. If the INR is greater than 3.0, it is usually necessary to withhold warfarin longer than 4 to 5 days. If the INR is measured the day before the surgical procedure and remains higher than 1.8, a small dose of vitamin K (1 to 5 mg administrated orally or subcutaneously) can reverse anticoagulation. Vitamin K has an effect within 6 to 10 hours after oral or subcutaneous administration (more predictable with oral administration), and it peaks within 24 hours to 48 hours. Administration of higher doses may lead to warfarin resistance when therapy is initiated again.