When patients on warfarin need surgery
Amir K. Jaffer, MD
Medical Director, The Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center and the Anticoagulation Clinic, Section of Hospital and Preoperative Medicine, Department of General Internal Medicine, The Cleveland Clinic
Daniel J. Brotman, MD
Section of Hospital and Preoperative Medicine, Department of General Internal Medicine, The Cleveland Clinic
Nkem Chukwumerije, MD
Kaiser Permanente Medical Center, Panorama, CA
Address: Amir K. Jaffer, MD, Department of General Internal Medicine, A72, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail: firstname.lastname@example.org
Dr. Jaffer has indicated that he has received grant or research support from Astra Zeneca, serves as a consultant for Aventis and Astra Zeneca, and is on the speakers’ bureau of Aventis.
This paper discusses therapies that are experimental or are not approved by the US Food and Drug Administration for the use under discussion.
ABSTRACTWhen a patient who has been taking warfarin long-term needs to undergo surgery, how to manage his or her anticoagulation is controversial. We believe most patients should stop taking warfarin 5 days before elective surgery, and most do not need to receive heparin in the perioperative period as a bridge to surgery.