Clinical Editor's Corner

When Is It Safe to Cath Someone on Coumadin?

MORTON KERN, MD Clinical Editor Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California mortonkern005@hotmail.com
MORTON KERN, MD Clinical Editor Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California mortonkern005@hotmail.com
Your patient has atrial fibrillation, chest pain and a positive stress test with risk factors for coronary disease, and is planning to undergo cardiac catheterization. The international normalized ratio (INR) is 2.2. When is it safe to perform coronary angiography on this individual? It is estimated that 5% of patients undergoing coronary angiography are on long-term warfarin therapy for a variety of clinical indications. Cardiac catheterization in a patient on warfarin is thought to be associated with an increased risk of bleeding and access site complications, especially after percutaneous coronary intervention (PCI). Generally, it is taught that arterial puncture for cardiac catheterization should not proceed until the INR is 3 than in patients with therapeutic periprocedural INRs (9.1% versus 1.5%; p
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