Inr normal range for surgery7/21/2023 ![]() ![]() Non-Steroidal Anti-inflammatory Drugs (NSAIDs) Interaction(s) with other Common Medicines used in the Perioperative Period Interaction(s) with Common Anaesthetic Agents Follow the advice provided by the Pre-operative Assessment Team / Haematology Team post-operatively if appropriate.Ĭonsider prophylactic LMWH, commenced a minimum of 2 hours (4 hours for patients with indwelling catheters) post-operatively until therapeutic LMWH can be restarted. Therapeutic LMWH should not be started until at least 48 hours after surgery associated with a high risk of bleeding 3. If there are concerns regarding oral absorption post-operatively consider replacing warfarin with therapeutic dose LMWH as clinically appropriate. mitral valve replacement) should be considered. During this time prophylactic doses of LMWH (or therapeutic dose if high risk of thrombosis e.g. ![]() If a patient has undergone complex surgery and there is a likelihood that the patient may need to return to theatre the Surgeon may decide to delay restarting warfarin for a few days. Warfarin has a slow onset of action restart on evening of operation providing adequate haemostasis and Surgeon agrees – either at usual dose 1, 3 or two days of double maintenance dose followed by usual dose 3. It is advisable not to restart warfarin until the epidural / nerve catheter has been removed 5. Therapeutic anticoagulation with warfarin is a relative contraindication to neuraxial anaesthesia. Neuraxial (Spinal / Epidural) Anaesthesia or Lumbar Punctures If INR therapeutic and surgery cannot be delayed for sufficient time to allow reversal with vitamin K, anticoagulation can be reversed with prothrombin complex concentrate 3 – discuss with Haematologist. If INR therapeutic and surgery can be delayed for 6 to 8 hours give 5mg intravenous vitamin K (phytomenadione) to restore coagulation factors 3. ![]() The last dose of therapeutic LMWH should be at least 24 hours before surgery 3 (see Low Molecular Weight Heparin monograph). If bridging is needed this should either be started after 2 or 3 doses of warfarin have been missed or, if checking INR, when INR falls below 2.0 1. This should allow the INR to fall to 1.4 by day of operation / procedure 5.Ĭheck INR on admission to ensure safe to proceed with surgery / procedure 3.īridging with Low Molecular Weight Heparin (LMWH)Ĭonsider risk of thrombosis and risk of bleeding to assess if patient needs bridging with therapeutic dose of LMWH in the perioperative period 3 (see Further Information). Dental procedures – providing INR 3.0 discontinue at least 5 days operation / procedure 1 – discuss with Haematologist.Warfarin may not need to be stopped for the following minor procedures (however it is still recommended that the international normalised ratio (INR) is checked approximately 7 days prior to the procedure to identify patients with a supra-therapeutic INR 1):. Perioperative warfarin decision-making should take into account the patient’s underlying thrombotic risk balanced against the bleeding risk associated with the surgery / procedure – see ‘A nticoagulants (Oral) – A General Overview’. Risk of bleeding and / or complications of bleeding if continued. Risk of cerebrovascular event (CVA) if omitted. Risk of venous thromboembolism (VTE) if omitted. ![]()
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