Perioperative management of warfarin and antiplatelet therapy.
Perioperative management of patients on warfarin or antiplatelet therapy involves assessing and balancing individual risks for thromboembolism and bleeding. Discontinuing anticoagulant and antiplatelet therapy is usually necessary for major surgery but increases the risk of thrombotic events. Bridge therapy, the temporary perioperative substitution of low-molecular-weight heparin or unfractionated heparin in place of warfarin, is an effective means of reducing the risk of thromboembolism but may increase the risk of bleeding. The timing of warfarin withdrawal and timing of the preoperative and postoperative components of bridge therapy are critical to balancing these risks. Perioperative management of antiplatelet therapy requires special care in patients with coronary stents; the timing of surgery relative to stent placement dictates management in these patients.
Jaffer
Amir K
AK
Division of Hospital Medicine, University of Miami Miller School of Medicine, PO Box 016760, Miami, FL 33101-6760, USA. ajaffer@miami.edu
D000572:American Heart Association; D000925:Anticoagulants / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014481:United States; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin