![]() Almost all patients will achieve an international normalized ration (INR) of 70 years) will require a longer period of warfarin withdrawal before surgery. Preoperative management of warfarin therapy consists of timely discontinuation of warfarin and replacement (known as “bridging”) with therapeutic low molecular weight heparin (LMWH) or unfractionated heparin if the risk of thrombosis is considered to be sufficiently high. It is recommended that the anesthesiologist and the surgeon be consulted in determining the hemorrhagic risk. The risk of hemorrhage in the perioperative period depends on the patient’s age, associated medical conditions, type of procedure, approach, site, type of incision and closure, and the method of administration of anesthesia and analgesia. The thrombotic risk in the perioperative period depends on pre-existing conditions, the time since the last episode of thrombosis, and the thrombotic effect of surgery. The management of warfarin therapy in patients undergoing surgery or other invasive procedures involves a fine balance between the risk of hemorrhage if the procedure was performed while on warfarin, and the risk of thrombosis if warfarin was discontinued.
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