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I've been taking Coumadin for the last two years for a blood-clotting problem I have. Well, now I have to have hip surgery. The surgeon and my regular doctor have worked out a whole schedule for when I should stop taking the Coumadin before the operation and then go back on it afterwards. My brother had the same thing exactly but his surgeon just did the operation without worrying about the risk of bleeding. Why the difference in policies?

Anticoagulation with Coumadin is a way to thin the blood and prevent blood clots that can travel to the heart, lungs, or brain and cause stroke or death. There's a lot of debate yet about the best way to handle situations like you described. Should patients on long-term anticoagulation therapy come off it before surgery to reduce the risk of bleeding? If so, how soon should the dosage be tapered and eliminated? Is three days enough? Does it take five days? Ten days? Different surgeons elect to follow different protocols based on personal experience and professional judgment. A recent survey asking surgeons just what their policies were in this area showed that about half the surgeons stopped the drug right before surgery. About 11 per cent waited at least five days and another 10 per cent waited 10 days. Twenty per cent operated immediately without changing the anticoagulation medication usage or dosage. There's enough evidence now to show that any delay in surgery for problems like hip fractures increases the risk of serious postoperative complications, including death. If it's an elective procedure and there's time to taper off the Coumadin, then that's what most surgeons instruct their patients to do. Different decisions are made when it's an emergency situation.

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