Anticoagulants and high bleeding risk surgery
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Anticoagulants and high bleeding risk surgery. These are major surgeries lasting >45 minutes. Fully referenced neurology checklist.
Approach to high bleeding risk procedures
- These are major surgeries lasting >45 minutes
- They are also operations that have a 2-4% risk of major bleeding within 2 days
- Temporarily stop Warfarin therapy about 5 days before the surgery
- Administer Vitamin K 1-2mg orally if the INR is >1.5 on the day of surgery
- Restart Warfarin 12-24 hours after surgery after haemostasis has been established
High bleeding risk procedures: urological
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High bleeding risk procedures: cardiac
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High bleeding risk procedures: gastrointestinal
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High bleeding risk procedures: neurological
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High bleeding risk procedures: others
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References
- Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl):e326S-e350S.
- Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133(6 Suppl):299S-339S.
- Spyropoulos AC, Douketis JD. How I treat anticoagulated patients undergoing an elective procedure or surgery. Blood 2012; 120:2954-2962.
- Douketis JD. Perioperative management of patients who are receiving warfarin therapy: an evidence-based and practical approach. Blood 2011; 117:5044-5049.
