PT  - JOURNAL ARTICLE
AU  - Amir K. Jaffer
TI  - Perioperative management of warfarin and antiplatelet therapy
AID  - 10.3949/ccjm.76.s4.07
DP  - 2009 Nov 01
TA  - Cleveland Clinic Journal of Medicine
PG  - S37--S44
VI  - 76
IP  - 10 suppl 4
4099  - http://www.ccjm.org/content/76/10_suppl_4/S37.short
4100  - http://www.ccjm.org/content/76/10_suppl_4/S37.full
SO  - Cleve Clin J Med2009 Nov 01; 76
AB  - 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.