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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.

  1. Ravindra Sen11 May, 2021

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

  2. Anonymous11 May, 2021

    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