Perioperative warfarin and bridging management

PIG Meeting: 4th March 2021

78yo female for cystoscopy.

Background:

  • AF – warfarinised. Distant TIA (2008)
  • IHD – CABG ’15
  • PPM for CHB
  • CKD
  • T2DM on insulin
  • PVD
  • HTN

Discussion:

  • Does this patient need bridging therapy?
    • This patient would be classed as moderate or high risk using the CHADS2 scoring, depending on the inclusion of her distant TIA as part of the ‘stroke/TIA/systemic emboli’ component.
    • ‘High risk’ (CHADS2 5 or 6) suggests bridging therapy is indicated.
    • With a ‘moderate risk’ (CHADS2 score 3 or 4), the decision to bridge is more at the discretion or the clinician, taking into account risk of surgical bleeding, individual patient factors, and patient preferences.

Note perioptalk.org website updated to standardise with approach on flipcharts in the perioperative clinic for perioperative management of anticoagulants.