![]() Other indications include arterial embolism, anti-phospholipid syndrome, renal, hepatic and other venous thromboses. ![]() Reduction of stroke and systemic embolism in patients with atrial fibrillation, transient ischaemic attacks (TIAs) and/or mechanical heart valves.Treatment of deep venous thrombosis and pulmonary embolism and prevention of recurrence.Oral anticoagulant therapy with warfarin is commonly prescribed for See the Guidelines for the Peri-operative Management of New Oral Anticoagulants for Patients Undergoing Elective Procedures. Patients who require bridging with heparin but have a documented allergy to it or have had a previous diagnosis of heparin induced thrombocytopenia should be discussed with haematology (coagulation registrar via switchboard). See the Management of Oral Anticoagulant and Antiplatelet Drugs in Patients Attending for Elective Endoscopy for patients undergoing endoscopic procedures. An INR safe to proceed with should be checked either the day before or on the day of surgery to ensure that the INR is not supra-therapeutic. minor dental, ophthalmological and dermatological procedures) may be performed whilst maintaining anticoagulation at the discretion of the Consultant. Some minor surgical procedures with a very low bleeding risk (e.g. Minor surgery that does not require interruption of anticoagulation This guideline applies to adult patients requiring interruption to warfarin or other vitamin K antagonists prior to elective procedures.Įmergency surgery in anticoagulated patients should be discussed urgently with haematology (coagulation registrar through switchboard). To provide evidence based recommendations for the management of perioperative anticoagulation. This guideline discusses the perioperative management of patients undergoing elective surgery who are taking warfarin and the role of ‘bridging’ therapy with heparin. **** Patients who have had a procedure with a very high risk of bleeding or bleeding complications during surgery may need to postpone their warfarin initiation until the surgeon is confident the bleeding risk has minimised. *** Continue prophylactic dose LMWH whilst INR is sub-therapeutic. ** CHA2DS2-VASc score includes more common stroke risk factors and superseded the CHADS2 score but only the CHADS2 has been validated for risk assessment within the peri-operative period and so is used for guiding the need for bridging anticoagulation therapy For patients on twice daily dosing of enoxaparin, the last dose should be administered at 08:00 on the morning before the day of surgery. *If patients are undergoing major surgery with a high bleeding risk or likely to have a spinal or epidural anesthesia it has been suggested the dose of therapeutic low molecular weight heparin (LMWH) may be halved the day before surgery. New date of surgery not confirmed or in more than two weeks Cancelled surgery > In light of a cancelled procedure please go straight to this section. ![]()
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