title: Perioperative Safety of Warfarin Therapy and Reversal.
abstract: BACKGROUND
  Warfarin is the most widely prescribed oral anticoagulant frequently encountered in the patients presenting for both elective and emergent surgery. Maintaining therapeutic levels of warfarin therapy may increase the risk of blood loss and procedural complications, including complications from neuraxial and regional anesthetic techniques. However, in some vulnerable patient groups, discontinuing therapy may result in negative thromboembolic consequences.
  
  
  OBJECTIVE
  To review the published guidelines and supporting data from clinical studies addressing the safe and coordinated management of patients on warfarin therapy who present for perioperative care.
  
  
  METHODS
  This review highlights the most up-to-date research from clinical trials as well as from retrospective studies in addition to multidisciplinary consensus guidelines regarding the safety of warfarin therapy and reversal in the perioperative period.
  
  
  RESULTS
  Based on the most up-to-date literature, certain patient groups may be more vulnerable to cessation of warfarin therapy before surgery and there exists a risk stratification algorithm. In many other cases, particularly emergent surgery, it may be necessary to reverse warfarin therapy preoperatively. There are anesthetic, surgical and safety implications in these clinical decision points.
  
  
  CONCLUSIONS
  With the aging of the United States population, the prevalence of preoperative patients therapeutic on warfarin will continue to increase, necessitating the multidisciplinary and coordinated care of perioperative clinicians to ensure patient safety and optimize clinical outcomes.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT 06520, USA. benjamin.maslin@yale.edu.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Maslin
authors.forename: Erin
authors.initials: E
authors.lastname: Springer
authors.forename: Richard
authors.initials: R
authors.lastname: Zhu
authors.forename: Vijay
authors.initials: V
authors.lastname: Kodumudi
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014859:Warfarin