1、诚信 奉献 求精 创新Warfarin Therapy Management During Invasive Procedures and Surgery急诊外科 张 荣诚信 奉献 求精 创新诚信 奉献 求精 创新 Scope Key Recommendations Risks Management诚信 奉献 求精 创新 Scope Key Recommendations Risks Management诚信 奉献 求精 创新Scope This guideline provides recommendations for the management of warfarin therapy
2、in adults aged 19 years requiring invasive procedures and surgery. Perioperative management of non-vitamin K antagonist oral anticoagulants can be found in BCGuidelines.ca Use of NOACs in Non-Valvular Atrial Fibrillation. Non-perioperative management of warfarin is covered in BCGuidelines.ca Warfari
3、n Therapy Management.诚信 奉献 求精 创新 Scope Key Recommendations Risks Management诚信 奉献 求精 创新Key Recommendations Warfarin discontinuation prior to invasive procedures is necessary for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without
4、biopsy, and percutaneous venous access. For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization of the international normalized ratio (INR). For urgent procedures, use of prothrombin complex concentrate is highly effective in rapidly
5、reversing warfarin anticoagulant activity and has a duration of action of 6 hours. The use of bridging heparin therapy is dependent on the risk of thrombosis. Discuss the risk of bleeding with the surgeon and anesthesiologist to determine optimal timing for resuming warfarin and bridging heparin the
6、rapy after surgery.诚信 奉献 求精 创新 Scope Key Recommendations Risks Management诚信 奉献 求精 创新Risks The management of warfarin therapy in patients undergoing surgery or other invasive procedures involves a fine balance between the risk of hemorrhage if the procedure was performed while on warfarin, and the ri
7、sk of thrombosis if warfarin was discontinued. The thrombotic risk in the perioperative period depends on pre-existing conditions, the time since the last episode of thrombosis, and the thrombotic effect of surgery. The risk of hemorrhage in the perioperative period depends on the patients age, asso
8、ciated medical conditions, type of procedure, approach, site, type of incision and closure, and the method of administration of anesthesia and analgesia. It is recommended that the anesthesiologist and the surgeon be consulted in determining the hemorrhagic risk诚信 奉献 求精 创新Risks Preoperative manageme
9、nt of warfarin therapy consists of timely discontinuation of warfarin and replacement (known as “bridging”) with therapeutic low molecular weight heparin (LMWH) or unfractionated heparin if the risk of thrombosis is considered to be sufficiently high. Almost all patients will achieve an internationa
10、l normalized ration (INR) of 70 years) will require a longer period of warfarin withdrawal before surgery. Patients with a high risk of thromboembolism or stroke may benefit from bridging with heparin during the preoperative period, either as outpatients (LMWH subcutaneously) or inpatients (unfractionated heparin intravenously) by shortening the duration of subtherapeutic anticoagulation.
