Question

A 60-year-old man with a mechanical mitral valve replacement (high risk) is taking Warfarin (INR 2.5-3.5). He requires major abdominal surgery (high bleeding risk). What is the most appropriate peri-operative anticoagulation management?

Accepted Answer

Stop Warfarin 5 days before surgery and bridge with therapeutic dose Low Molecular Weight Heparin (LMWH)

Answer

Continue Warfarin uninterrupted

Answer

Stop Warfarin 5 days before surgery and restart post-operatively when haemostasis is secure

Answer

Stop Warfarin 2 days before surgery and bridge with prophylactic dose LMWH

Answer

Reverse Warfarin with Vitamin K immediately before surgery

Practice question

A 60-year-old man with a mechanical mitral valve replacement (high risk) is taking Warfarin (INR 2.5-3.5). He requires major abdominal surgery (high bleeding risk). What is the most appropriate peri-operative anticoagulation management?