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Introduction: It may be possible to safely perform some procedures without interrupting warfarin therapy. Coronary angiography with or without percutaneous coronary intervention (PCI) is one such procedure. However, before further high quality research can be performed in this area, information such as current practice and associated event rates is required., Materials and Methods: We performed a retrospective chart review of 100 charts from a tertiary interventional cardiology referral centre. The primary outcome was access site bleeding. The perioperative anticoagulation strategy for each patient was also recorded., Results and Conclusions: All patients were managed with a strategy of warfarin interruption with or without bridging with a heparin. This was associated with an access site event rate of 2%. These results can be used to inform the design of high quality prospective studies, aimed at determining optimal anticoagulation management strategy in warfarin-treated patients who require coronary angiography or PCI., ((c) 2009 Elsevier Ltd. All rights reserved.)

Background: In patients who are receiving warfarin therapy and require cataract surgery, it may be possible to continue warfarin in the perioperative period but the safety of this management strategy has not been systematically evaluated., Methods: We performed a systematic review of the literature to assess the safety (bleeding events) of continuing warfarin before and after cataract surgery. We included studies that enrolled patients undergoing cataract surgery who were anticoagulated with warfarin alone and that reported bleeding events as an outcome. Study quality was assessed using a validated form. Odds ratios and bleeding rates were pooled to give summary estimates of bleeding risk., Results: We identified 11 studies (5 cohort and 6 case series) assessing bleeding risk associated with warfarin continuation during cataract surgery. Patients who continued warfarin had an increased risk for bleeding (odds ratio; 3.26; 95% confidence interval [CI]: 1.73-6.16). The overall incidence of bleeding (95% CI) was 10% (5-19). Almost all bleeding events were self-limiting and not significant, consisting of dot hyphemae or subconjunctival hemorrhages. No patient had compromised visual acuity related to a bleeding event., Conclusion: Patients who are receiving warfarin therapy and undergo cataract surgery without warfarin interruption have an increased risk for bleeding but such bleeds are not clinically significant. The low quality of studies assessed, however, precludes definitive conclusions as to the risk for bleeding in patients who continue warfarin around the time of cataract surgery.