Perioperative Anticoagulant Management

The oral anticoagulant warfarin is a common medication that requires special consideration in the perioperative period. Although some procedures do not require warfarin interruption, the majority will necessitate its temporary cessation due to the risk of bleeding. Determining whether patients will benefit from the temporary use of a heparin product while warfarin is discontinued perioperatively (so-called "bridging" therapy) needs to take into consideration the risk of bleeding balanced with the risk of thromboembolism. Perioperative care also requires minimizing the risk of venous thromboembolism (VTE). Understanding the patient-specific and procedure-specific risks for VTE is paramount to employ optimal risk reduction strategies. This article uses a case-based approach to present the topics of perioperative warfarin management and postoperative VTE prevention.