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MANAGEMENT OF ANTICOAGULATED PATIENTS
THROUGH SURGERY
|
| Category |
Management |
| Low risk
patients ie on warfarin for: atrial fibrillation, DVT, PE, Recurrent
VT, Arterial Disease |
1) Stop
warfarin 3 days pre-op
2) Aim for INR <2.5 immediately pre-op
3) If INR <1.5 immediately pre-op consider usual
thromboprophylaxis for type of operation proposed.
4)Restart oral anticoagulation at normal maintenance dose on the
evening following the operation when the patient is able to tolerate
oral medication.
|
| Intermediate
Risk Patients ie Patients
with mechanical heart valve replacements |
Minor
ops – i.e. when the patient can be expected to resume warfarin
within 24 hours post-op - as above
Major ops – when they will be expected to be unable to take oral
warfarin for more than 24 hours - as below |
| Patients
with life threatening thrombosis |
1) Aim
to admit the patient one day pre-op with INR of approx. 2.5 (for a
stable anticoagulant patient with a mitral mechanical valve
replacement (INR therapeutic range 3.0-4.0), advise patient to stop
warfarin 3 days pre-op)
2)
Check INR/APTT daily from admission and when the INR is
<3.0 start IV heparin infusion (20,000-40,000 IV/day).
3) Maintain
heparinisation pre and post-operatively
4)
Convert to warfarin post-op once patient is stable
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