Is continuing warfarin in the perioperative period safe for patients undergoing urologic procedures?

摘要

The perioperative management of patients necessitating long-term anticoagulation remains controversial because there remains a careful balance between increased risk of bleeding and thromboembolic events. Many of these high-risk patients are on warfarin oral anticoagulation for a mechanical heart valve, chronic atrial fibrillation, or prior history venous thromboembolism [1]. Prior studies have confirmed the safety and efficacy of discontinuation of warfarin with initiation of therapy with intravenous (IV) heparin or low-molecular-weight heparin (LMWH) as "bridging" therapy [2], The 2008 American College of Chest Physicians consensus statement [1 ] for the management of patients receiving vitamin K antagonists (ie, warfarin) and who require invasive procedures includes various strategies for discontinuing warfarin therapy and initiating heparin bridging therapy.