another example of perioperative management of INR around a small procedure

I needed to have a little surgery to remove arthritis from my toe, so this being a peripheral surgery where bleeds were less likely (because of bloodless surgery possible on peripheral limbs and thus less life threatening) I perhaps took a little slacker approach on my management of  Anti Coagulation Therapy (ACT , aka warfarin).

Its just a day after hospital, so too early to talk about outcomes, but it feels like everything went well so far.

So my plan was to replicate what I did in my previous surgical procedure (which btw has a much higher risk of fatal bleeds) but perhaps act a little more conservatively on the cessation of ACT 

My procedure was slated for PM on Friday the 16th, accordingly my plan was this:

• half dose evening (regular dose time) for evening before procedure
• no dose on the evening of the procedure (after it)
• resume dose following day (evening)

Given what I found I probably should have reviewed more closely what I identified in the previous situation and gone with zero dose the evening before as well ... perhaps half the day before that.

A few more data points before the 16th would have been good, but it would seem that my INR didn't shift much (or was higher than 3 on the 14th 15th and I didn't know) as a result of the half dose and indeed rise after surgery.

Further I'd suggest that the small rise in INR despite the significant drop in dose suggests that if I had simply continued that its possible my INR may have gone higher (to perhaps 4) in the period soon after surgery. Something best avoided. So next time (I hope not, but probably there'll be) I'll monitor daily (to get data) and reduce dose to half earlier and withhold the day before the surgery.

Either way now is still a good time to have a reduced INR during post operative healing, so I'll be steering towards INR = 2 for the next week