Frequently Asked Questions

Coumadin: when to stop and restart?


Coumadin (warfarin) is a blood thinner

Coumadin is a very commonly used blood thinner. The generic name is “warfarin”. Coumadin is frequently used for people with DVT (blood clots), and for people who have heart arrhythmias, such as A-Fib, or atrial fibrillation. Both of these situations are more common in patients with hyperparathyroidism–the parathyroid tumor can cause this.

Stop 5 days prior to parathyroid surgery

Coumadin has been around for decades, and for decades it has been standard for people to stop this drug for 5 days prior to surgery. This is what we do.

Re-start the evening of parathyroid surgery

For parathyroid surgery performed at the Norman Parathyroid Center, we prefer our patients to start taking their Coumadin (warfarin) the evening of the operation.

Can’t stop Coumadin? We are perfectly fine with that!

Some of our patients at the Norman Parathyroid Center are told by their doctor or cardiologist that they cannot stop the Coumadin. That is fine with us!  We have absolutely no problem whatsoever with performing parathyroid surgery on patients who cannot stop their Coumadin. We’ve done it hundreds and hundreds of times and to tell you the truth, we can’t tell the difference. We have never had a bleeding problem after one of our parathyroid patients because they were still taking Coumadin. The operation is exactly the same. There is no increased blood loss during the operation–we literally can’t tell during the operation if somebody is taking Coumadin.

So if your doctors are telling you that you need to stop the Coumadin and get started on heparin (a different blood thinner), then you can tell them this is absolutely not necessary at our Center. We operate on people who are still taking Coumadin at least once a week.

Bottom line for our parathyroid patients

Taking Coumadin poses a theoretical increased risk of bleeding during and for the first few hours after surgery. We prefer our patients to stop taking it for 5 days to decrease this potential risk. However, in the real world, our experience with hundreds of patients who are still taking Coumadin, is that it doesn’t affect the operation at all, and it can be done very safely. The risk is real, but it is very small. Having a parathyroid tumor in your neck poses a much higher risk!