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Article

Perioperative management of warfarin and antiplatelet therapy

Amir K. Jaffer, MD, FHM
Cleveland Clinic Journal of Medicine November 2009, 76 (10 suppl 4) S37-S44; DOI: https://doi.org/10.3949/ccjm.76.s4.07
Amir K. Jaffer
Associate Professor of Medicine and Chief, Division of Hospital Medicine, University of Miami Miller School of Medicine, Miami, FL
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ABSTRACT

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.

  • © 2009 The Cleveland Clinic Foundation. All Rights Reserved
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Cleveland Clinic Journal of Medicine: 76 (10 suppl 4)
Cleveland Clinic Journal of Medicine
Vol. 76, Issue 10 suppl 4
1 Nov 2009
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Perioperative management of warfarin and antiplatelet therapy
Amir K. Jaffer
Cleveland Clinic Journal of Medicine Nov 2009, 76 (10 suppl 4) S37-S44; DOI: 10.3949/ccjm.76.s4.07

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Perioperative management of warfarin and antiplatelet therapy
Amir K. Jaffer
Cleveland Clinic Journal of Medicine Nov 2009, 76 (10 suppl 4) S37-S44; DOI: 10.3949/ccjm.76.s4.07
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