7 - Surgery - Warfarin bridging therapy Flashcards Preview

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Flashcards in 7 - Surgery - Warfarin bridging therapy Deck (24):
1

How many days pre-surgery should you stop warfarin

5 days

2

How many days pre-surgery should you stop warfarin

5 days

3

What should be done with warfarin in emergency surgery

Vit K reversal (4-24 hours)
or
Beriplex reversal (1 hour) - this is a dried prothrombin complex containing variable amounts of clotting factors

4

What INR is required for surgery to proceed

5

What is considered a low VTE risk requiring no pre-op LMWH

CHA2DS2VASc 0-2 and not prior stroke/TIA

Single VTE >12 months ago

No risk factors

6

What is considered moderate VTE risk

CHA2DS2VASc 3-4

Recurrent VTE, or VTE in past 3-12 months

Active cancer

7

What should be done pre-op for moderate VTE risk?

Start therapeutic dose LMWH two days after stopping warfarin

8

What is considered high VTE risk?

CHA2DS2VASc score 5-6 with any prior stroke/VTE

Recent stroke/TIA/VTE
Mitrial stroke/valve prosthesis

9

What should be done for patients with high VTE risk pre-op?

LMWH two days after stopping warfarin OR

admit for UFH infusion once INR

10

What should be done with warfarin in emergency surgery

Vit K reversal (4-24 hours)
or
Beriplex reversal (1 hour) - this is a dried prothrombin complex containing variable amounts of clotting factors

11

What INR is required for surgery to proceed

12

What is considered a low VTE risk requiring no pre-op LMWH

CHA2DS2VASc 0-2 and not prior stroke/TIA

Single VTE >12 months ago

No risk factors

13

What is considered moderate VTE risk

CHA2DS2VASc 3-4

Recurrent VTE, or VTE in past 3-12 months

Active cancer

14

What should be done pre-op for moderate VTE risk?

Start therapeutic dose LMWH two days after stopping warfarin

15

What is considered high VTE risk?

CHA2DS2VASc score 5-6 with any prior stroke/VTE

Recent stroke/TIA/VTE
Mitrial stroke/valve prosthesis

16

What should be done for patients with high VTE risk pre-op?

LMWH two days after stopping warfarin OR

admit for UFH infusion once INR

17

What should be done for patients with high VTE risk pre-op?

LMWH two days after stopping warfarin OR

admit for UFH infusion once INR

18

What is the advantage of using a heparin before surgery instead of warfarin

shorter half life so patients can be fully anticoagulated before surgery

19

When should the last dose be given before surgery:

Warfarin
LMWH
UFH

Warfarin - six days before
LMWH - (morning the day before) do not give on morning of surgery
UFH - six hours before

20

when do we want to start warfarin after surgery?

What should we do until then for
low VTE risk
moderate/high risk
v high risk (mechanical heart vales)

ASAP - depending on bleed risk

Cover until INR is therapeutic:
LOW RISK - prophylactic LMWH
MODERATE/HIGH - treatment LMWH

MECHANICAL HEART VALVE - IV UFH

21

in practice when is warfarin started after surgery?

not the evening of surgery as fears that they might need surgery again.
BUT ASAP after that.

must be on warfarin for discharge.

must have INR in range before stopping heparin

22

in practice when is warfarin started after surgery?

not the evening of surgery as fears that they might need surgery again.
BUT ASAP after that.

must be on warfarin for discharge.

must have INR in range before stopping heparin

23

If a prohplactic dose of LMWH is required post-op when do we start this?

LOW BLEED RISK - eve post-op

HIGH BLEED RISK - 24-48h post-op

24

If a theraputic dose of LMWH is required post-op when do we start this?

LOW BLEED RISK - 24-48h post-op

HIGH BLEED RISK - start a prophylatic dose 24-48h, then a theraputic dose 48-72 hours post-op