When should warfarin be stopped prior to an ERCP procedure?

Warfarin is an anticoagulant that requires careful management prior to surgical procedures to minimize the risk of bleeding. The timing of its discontinuation before an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure is important to ensure patient safety.

Stopping warfarin 5 days before the procedure allows for adequate time for the INR (International Normalized Ratio) to return to a safer range, reducing the risk of excessive bleeding during the procedure. This timing aligns with the halving of warfarin's anti-coagulation effect due to the depletion of vitamin K-dependent clotting factors, which typically takes several days to return to baseline.

Discontinuing warfarin at an earlier time frame, such as 3 days or 1 week, could either lead to unnecessary bleeding risk if not enough time is given for factor normalization or might prolong the patient’s stay on anticoagulation unnecessarily. Stopping the medication the night before may not provide sufficient time for adequate recovery of the coagulation status and could increase the risk of bleeding complications during the procedure. Thus, stopping warfarin 5 days prior is considered the safest and most effective approach for ERCP.