RT Journal Article
SR Electronic
T1 Perioperative management of warfarin and antiplatelet therapy
JF Cleveland Clinic Journal of Medicine
JO Cleve Clin J Med
FD Cleveland Clinic
SP S37
OP S44
DO 10.3949/ccjm.76.s4.07
VO 76
IS 10 suppl 4
A1 Jaffer, Amir K.
YR 2009
UL http://www.ccjm.org/content/76/10_suppl_4/S37.abstract
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.