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When patients on warfarin need surgery
Amir K Jaffer1, Daniel J Brotman, Nkem Chukwumerije
1The Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center, Department of General Internal Medicine, The Cleveland Clinic Foundation, OH 44195, USA. jaffera@ccf.org
Cleveland Clinic Journal of Medicine
|December 3, 2003
Summary
For patients on long-term warfarin therapy needing surgery, stopping warfarin 5 days prior is recommended. Most patients do not require heparin bridging therapy during the perioperative period.
Area of Science:
- Cardiology
- Perioperative Medicine
- Pharmacology
Background:
- Managing long-term warfarin anticoagulation for elective surgery presents a clinical challenge.
- Current guidelines offer varied recommendations for perioperative anticoagulation management.
Purpose of the Study:
- To provide a clear recommendation for managing warfarin in patients undergoing elective surgery.
- To evaluate the necessity of heparin bridging therapy in this patient population.
Main Methods:
- Literature review and expert consensus on warfarin management.
- Analysis of risks and benefits of stopping warfarin versus continuing or bridging with heparin.
Main Results:
- Warfarin cessation 5 days before elective surgery is suggested for most patients.
- Heparin bridging is deemed unnecessary for the majority of patients in the perioperative period.
Conclusions:
- A simplified approach to warfarin management before surgery can be adopted.
- Reducing unnecessary heparin use can decrease patient risk and healthcare costs.