How does anticoagulation affect perioperative cardiac management?

Updated: Feb 06, 2020
  • Author: Davinder Jassal, MD; Chief Editor: William A Schwer, MD  more...
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The clinician must remember that patients with atrial fibrillation and prosthetic heart valves are on anticoagulation therapy. Warfarin (Coumadin) therapy should be discontinued 4-5 days before elective surgery, given its half-life. Patients at high risk for thromboembolic events include those with prosthetic valves in the mitral position, atrial fibrillation associated with mitral valve disease, and a history of thromboembolism. Such patients should be admitted for intravenous heparin treatment. Outpatient therapy with preoperative low molecular weight heparin instead of conventional unfractionated intravenous heparin is often used, although no randomized controlled trials have validated this protocol. Patients with highly thrombotic valves (eg, Star-Edwards valve), 2 prosthetic valves, or recent arterial embolism should be considered for standard intravenous heparin therapy perioperatively.

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