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How long surgery must be delayed in cases of acute venous thromboembolism?

Asked by Eurona 

It is advised to delay surgery until the patients receive atleast 1 month and preferably 3 months of anticoagulation whenever feasible.

However, where surgery needs to be performed:

Within 1 month of acute VTE: Intravenous UFH should be administered while the INR is less than 2.

Within 2 weeks of acute VTE: Intravenous heparin may be withheld 6 hours preoperatively and 12 hours postoperatively, if the surgery is short. 

If the acute event was within 2 weeks of major surgery and/or patients have a higher risk of postoperative bleeding, a vena caval filter should be inserted preoperatively or intraoperatively.

Warfarin should be withheld for only 4 doses if the most recent episode of VTE occurred 1-3 months before surgery. If the patient has been anticoagulated for 3 or more months, 5 doses of warfarin can be withheld before surgery. Preoperatively, subcutaneous UFH or LMWH is needed only for immobilized inpatients with an INR of less than 1.8.

https://www.medscape.com/answers/285265-94364/what-is-the-perioperative-anticoagulation-management-of-patients-with-venous-thromboembolism-vte

  1. Why is heparin co-administered with warfarin for vte prophylaxis? is there any place for use of warfarin alone?

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  2. There are 2 main reasons for this:
    1. Onset of warfarin is delayed, starts in about 5 days after starting the administration
    2. Warfarin not only inhibits coagulation factors but also Protein C and S which are Vitamin K dependent and may paradoxically create hypercoagulable state

    Hence, bridging with heparin is necessary

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