Correction of Anticoagulation in Surgical Patients

Patients may be anticoagulated for many reasons. Ultimately, recommendations for reversal of anticoagulation for both major or minor surgical procedures are as indicated in the following section.

If a patient is therapeutic with their coumadin therapy, four scheduled doses should be withheld prior to surgery to allow the INR to drop to >1.5. The INR should be measured the day before surgery and further corrected if necessary. If heparin is required it should not be restarted until 12 hours after surgery and delayed if there is any evidence of bleeding.

Only patients with a history of acute thromboembolism (<1 month) need continuous anticoagulation with heparin pre- and postoperatively. Patients with heart valves and atrial fibrillation do not require preoperative heparin therapy. The risk for embolic events in the short term is small ranging between 0.3% to 1.1% at two weeks (Table 3.5).

Table 3.5. Management of anticoagulated patients

Indication Before Surgery After Surgery

Acute venous thromboembolism

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