Previous stroke/TIA ever with 3 of following risk factors: CCF, HTN, >75yoa, Diabetesīack to top Management of Bleeding and of High INR in the absence of Bleeding.Metallic valve other than bileaflet aortic valve.Stroke/TIA/VTE within previous 3 months, (Please consider delaying surgery).Pre-operative bridging therapy (with treatment dose LMWH) should be considered if the thrombotic risk is especially high: Warfarin should not be taken for 5 days before surgery and, if possible, the INR should be determined the day before surgery to allow the administration of vitamin K if the INR is ≥1.5, so reducing the risk of cancellation.For elective surgery, warfarin should be stopped to allow the INR to fall slowly back to normal prior to the procedure. Peri-operative anticoagulationįor some invasive procedures, such as joint injections, cataracts and low risk endoscopic procedures (see BSG Guidelines) warfarin does not need to be stopped if the INR is in the therapeutic range.Īs a general rule, warfarin should only be reversed for emergency surgery. This guideline aims to give advice and support in the treatment of patients admitted for surgery or treatment who are taking warfarin for anticoagulation. ![]() Flowchart for the management of warfarin reversalįor guidance on the Indication Codes for the use of red cells, fresh frozen plasma, cryoprecipitate, platelets and prothrombin complex concentrate issued by the National Blood Transfusion Committee, supported by NICE NG24 2015, please see: Link.Management of Bleeding and of High INR in the absence of Bleeding. ![]() Management of Warfarin Reversal (in Adults)
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