The warfront

This is one classic area that surgeons and physicians have a constant battle – a patient is on warfarin, and the question arises about how risky it is to stop it, and what kind of management the patient should have peri-operatively. Can it just be stopped? Should it be immediately reversed? Do they need a heparin infusion? So many choices – and now, one place to look. 

The editors of Blood have made this guideline free for all, looking at the perioperative management of those that are on warfarin therapy. They set out to answer five major questions:

  1. How to stratify patients according to risk for thromboembolism and bleeding?
  2. When is perioperative interruption of warfarin therapy not required?
  3. If warfarin interruption is required, when should it be stopped and resumed?
  4. If warfarin therapy is stopped, when is heparin bridging required?
  5. How should heparin bridging be given before and after surgery, and at what dose?
Fantastic article, and even has a pair of practical cases to test yourself at the end, and some take home algorithms. Check this one out over here

IMAGE crucially

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