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Warfarin Perioperative Management — RACP Adult Medicine MCQ

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ModerateHaematologyWarfarin Perioperative ManagementRACP Adult Medicine

A 55-year-old man on warfarin (INR 2.8) for AF (CHA₂DS₂-VASc 4) is scheduled for elective colonoscopy with polypectomy in 5 days. He has no history of VTE or mechanical valve. What is the most appropriate perioperative anticoagulation strategy?

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Correct answer: A — Stop warfarin 5 days before, no bridging, restart post-procedure

For AF without very high-risk features (no mechanical valve, no recent stroke/VTE within 3 months), warfarin bridging with LMWH is NOT recommended (BRIDGE trial: bridging increased major bleeding without reducing thromboembolism). Stop warfarin 5 days before procedure (allows INR to fall <1.5), proceed with procedure, and restart warfarin that evening or next day.

Reference: BRIDGE Trial; CSANZ 2024; eTG Haematology 2024