Question

A 57-year-old with atrial fibrillation on apixaban develops bacterial endocarditis requiring urgent valve surgery. What to do with anticoagulation pre-op?

Accepted Answer

Hold apixaban; no bridging in most cases

Answer

Continue apixaban until surgery

Answer

Bridge with LMWH after stopping apixaban

Answer

Switch to warfarin and keep INR 2-3 to surgery

Answer

Give vitamin K

Practice question

A 57-year-old with atrial fibrillation on apixaban develops bacterial endocarditis requiring urgent valve surgery. What to do with anticoagulation pre-op?