Annotations Other Considerations
  • Avoid IM injections and arterial punctures
  • Hold warfarin for 2 doses prior to immunizations, then restart usual dose of warfarin the following day.
  • Avoid aspirin, NSAIDs and other antiplatelet drugs unless required for specific disease management or clinical situation
  • Consider alternative analgesics such as acetaminophen or choline magnesium trisalicylate (Trilisate®), as clinically appropriate, if analgesia is required
  • No contact sports - but other normal activities are allowed
  • Teenage pregnancy
    • Warfarin should not be used
    • Teenagers need to receive appropriate counseling
    • Enoxaparin (Lovenox®) is the treatment of choice for teens who require anticoagulants during pregnancy.
  • Surgery/invasive procedures
    • Discontinue warfarin 5 days prior to surgery/invasive procedures such as lumbar puncture unless the clinical situation requires an emergent intervention. For conditions necessitating more emergent intervention consult hematology
    • Resume warfarin 12 to 24 hours after surgery/invasive procedures
    • Patients with mechanical/prosthetic valves, atrial fibrillation or recent/recurrent thromboembolism require bridging with standard heparin or low molecular weight heparin. Consult hematology or cardiology (for specifically cardiac related problems)
  • Patients should consult physician for the following:
    • Significant changes in diet, formula intake for infants
    • Introduction of new medication (e.g. antibiotics) and any over-the-counter medication
    • Changes in doses of on-going medications
    • Infections
    • Diarrhea and vomiting


These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.

Copyright © 1996-2014 The Children's Mercy Hospital