Endocrinology / Head and Neck Surgery

Thromboembolic Risks

For most procedures, perioperative management will be driven by thromboembolic risk.

Anticoagulants should not be discontinued without consultation with the provider who is managing the anticoagulants to avoid significant issues.

Bleeding Risks

Bruising and hematoma formation is possible.

General Recommendations for Pre-Procedure Warfarin Management

Small skin and mucosal biopsies, neck masses, salivary gland  and thyroid biopsies can be done safely without interruption of anticoagulation as 22-25 gauge needles are generally used.

If possible, a 3-5 day warfarin hold will minimize bruising and hematoma potential.


Safety of ultrasound-guided fine needle aspiration biopsy of neck lesions in patients taking antithrombotic/anticoagulant medications. Abu-Yousef MM, Larson JH, Kuehn DM, Wu AS, Laroia AT. Ultrasound Q. 2011 Sep;27(3):157-9.

Special thanks to Charles Choe, MD and Kevin Brumund, MD for their expert guidance.