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Hi
I have a (up until this incident) healthy patient who is due to have nail surgery for an infected ingrowing nail on 17.09.13 and had a DVT in the same leg on 21.08.13.
She is on 16mg Warfarin a day and her INR is 1.4.
My query is, should still go ahead with nail surgery this soon after a DVT?

Thanks, all info gratefully received.....

Judith

 

Her INR is outside the normal range and carrying out minor without consultation with the warfarin clinic and consultant would not be advised hope this helps

 

I agree with Colm; 1.4 is too low. It really is a matter of clinical judgement and depends on the severity of the infection. It is crucial to have a case conference with the relevant consultant before embarking on surgery. The physician will probably be able to tweak the meds.

All the best

Bill

 

Hi Judith, your patient's INR is only just outside the normal range (1-1.2).
Most recommendations suggest that minor surgery can be safely carried out as long the INR levels are within therapeutic range indeed guidelines we have developed along with our haematology department recommend nail surgery can proceed as long as the INR is below 4.
I've attached our guidelines which contain some other considerations when treating these patients.
My experience is these patients bleed a lot less than one anticipates.
I would have no problem progressing with nail surgery on this patient.
Michael

 

Hello Judith

Normal INR values, in the absence of anti-coagulation therapy, is about 0.8/0.9-1.1/1.2. The use of anticoagulants, such as warfarin, raises this to 2-3.
Minor procedures such as NWR/PNA do not usually require anti-coagulation therapy to be stopped and surgery is considered safe if the INR is <1.5.