Variations in Perioperative Warfarin Management: Outcomes and Practice Patterns at Nine Hospitals

Antiplatelet Therapy and Anticoagulation

“…They include phenprocoumon, warfarin, and acenocoumarol. In elective perioperative settings, these drugs are replaced by UFH, LMWH, or fondaparinux, as these periods are associated with a thromboembolic risk of 0-2 % if VKA are interrupted (Mourelo et al 2008 ) and a bleeding risk of 2-25 % if VKA are continued during surgery (Jaffer et al 2010 ). There are several ways to reverse the anti-vitamin K effect.…”

Pro: “Bridging anticoagulation is needed during warfarin interruption in patients who require elective surgery”

“…However, the studies were of poor methodological quality, with poorly described bridging strategies, making conclusions difficult to interpret. Since publication of that systematic review, there have been multiple moderatesized and multicentre prospective cohort studies assessing bridging anticoagulation in over 7,169 patients after VKA interruption for elective procedures or surgeries (5)(6)(7)(8)(9)(10)(11). These studies included well-described patient groups on VKA, well-described procedures, a specified bridging protocol (usually with LMWH) with well-defined follow-up periods and validated and objectively verified study outcomes, including ATE, venous thromboembolism (VTE), major bleeding, and death (ǠTable 1).…”

Perioperative management of patients who are receiving warfarin therapy: an evidence-based and practical approach

“…Therapeutic-dose LMWH (and UFH) has been shown to be associated with a higher risk of major bleeding compared with low-dose LMWH or UFH regimen or no bridging (OR: 4.4; 95% CI: 1.5-14.7) in a prospective multicenter registry. 5 Consequently, its perioperative use should be judicious and tailored to the type of surgery so as to minimize bleeding risk.…”

“…Added to these varied perceptions of thromboembolic risk is the wide range of surgical and other invasive procedures that patients undergo and clinicians' differing perceptions of associated bleeding risk. 5,6 Overall, the perceived risk for thromboembolism will likely drive patient management, 6 and if it is perceived to be greater than the risk for bleeding, this will determine whether heparin bridging is administered during warfarin interruption.…”