Key result
Bridge therapy with low-molecular-weight heparin or unfractionated heparin reduces the risk of thromboembolism during perioperative warfarin interruption but may increase the risk of bleeding.
Perioperative management of anticoagulants and antiplatelets requires careful balancing of thrombotic and bleeding risks, particularly regarding bridge therapy and timing around coronary stents.
May inform individualized perioperative bridging decisions; leaves open net benefit without randomized confirmation.
Perioperative management of patients on warfarin or antiplatelet therapy involves assessing and balancing individual risks for thromboembolism and bleeding. Discontinuing anticoagulant and antiplatelet therapy is usually necessary for major surgery but increases the risk of thrombotic events. Bridge therapy, the temporary perioperative substitution of low-molecular-weight heparin or unfractionated heparin in place of warfarin, is an effective means of reducing the risk of thromboembolism but may increase the risk of bleeding. The timing of warfarin withdrawal and timing of the preoperative and postoperative components of bridge therapy are critical to balancing these risks. Perioperative management of antiplatelet therapy requires special care in patients with coronary stents; the timing of surgery relative to stent placement dictates management in these patients.
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Amir K. Jaffer (2009) conducted a review in Patients on warfarin or antiplatelet therapy undergoing surgery. Perioperative management of warfarin and antiplatelet therapy (Bridge therapy) was evaluated. Bridge therapy with low-molecular-weight heparin or unfractionated heparin reduces the risk of thromboembolism during perioperative warfarin interruption but may increase the risk of bleeding.
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