Thirty-nine patients receiving warfarin with an INR of between 1.3 and 2.9 underwent a total of 55 hand procedures without interruption in warfarin dosing. The operations were varied, including skin grafting, skin rearrangement, lesion excision, fasciectomy, tenosynovectomy, carpal tunnel release, fracture fixation, and joint arthroplasty. No problems with intraoperative hemostasis were reported. Two patients had minor bleeding-related complications which required no additional surgery and which led to no long-term sequelae.
Interruption of anticoagulation in patients taking coumadin for atrial fibrillation, a mechanical heart valve, or previous thromboembolism may pose an increased risk for a thromboembolic event. Temporary cessation of warfarin and administration of low-molecular weight heparin is a proven means of manipulating anticoagulation peri-operatively, but can be difficult to effectively coordinate in an outpatient setting. The authors of this study concluded that interruption of warfarin therapy in hand surgery is unnecessary if the INR is less than 3.0. In a separate report of 22 patients on warfarin anticoagulation undergoing either a carpal tunnel release or Dupuytren’s fasciotomy, Smit and Hooper (JHS Br, 2004) drew a similar conclusion; limited to these 2 procedures.
J Hand Surg 29B:201-203, 2004.