Management of Anticoagulation before and after Elective Surgery

doi:10.1056/NEJM199705223362107

Volume 336:1506-1511		May 22, 1997		Number 21

Management of Anticoagulation before and after Elective Surgery

Clive Kearon, M.D., Ph.D., and Jack Hirsh, M.D.

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The most common indications for warfarin therapy are atrialfibrillation, the presence of a mechanical heart valve, andvenous thromboembolism.¹^,² Treatment with warfarin presentsa problem if patients with these indications need surgery, becausethe interruption of anticoagulant therapy increases the riskof thromboembolism. After warfarin therapy is discontinued,it takes several days for its antithrombotic effect to recede,and when it is resumed, several days are needed to reestablishtherapeutic anticoagulation.

There is no consensus on the appropriate perioperative managementof anticoagulation for patients who have been receiving long-termwarfarin therapy. Rational decisions about the treatment ofsuch patients . . . [Full Text of this Article]

Risks Associated with Temporarily Stopping Warfarin Therapy

Risks of Thromboembolism in Specific Settings

Venous Thromboembolism

Arterial Thromboembolism

Mechanical Heart Valves

Risk of Bleeding

Consequences of Thrombosis and Bleeding

Risks and Benefits of Perioperative Intravenous Heparin

Venous Thromboembolism

Arterial Thromboembolism

Qualifying Remarks

Recommendations

Patients with a History of Venous Thromboembolism

Patients at Risk for Arterial Thromboembolism

Source Information

From McMaster University and Hamilton Civic Hospitals Research Centre, 711 Concession St., Hamilton, ON L8V 1C3, Canada, where reprint requests should be addressed to Dr. Kearon.

References

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N Engl J Med 1997; 337:938-940, Sep 25, 1997. Correspondence

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