Management of Anticoagulation before and after Elective Surgery

The most common indications for warfarin therapy are atrial fibrillation, the presence of a mechanical heart valve, and venous thromboembolism.1,2 Treatment with warfarin presents a problem if patients with these indications need surgery, because the interruption of anticoagulant therapy increases the risk of thromboembolism. After warfarin therapy is discontinued, it takes several days for its antithrombotic effect to recede, and when it is resumed, several days are needed to reestablish therapeutic anticoagulation.There is no consensus on the appropriate perioperative management of anticoagulation for patients who have been receiving long-term warfarin therapy. Rational decisions about the treatment of such . . .