🌉 Perioperative Anticoagulant/Antiplatelet Bridging
Perioperative management of warfarin (bridging), DOACs (interruption/resumption) and antiplatelets, per CHEST 2022/ACC/ASRA. Browser-side reference.
Most atrial fibrillation does not need bridging.
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When to use
Decide whether and how to interrupt and bridge anticoagulation around surgery, balancing bleeding against thrombosis.
How it works
Warfarin: stop ~5 days pre-op, bridge only if high thrombotic risk. DOAC: stop 1–4 days by drug/renal function/bleeding risk, no bridging.
Key points
- Most atrial fibrillation does not need bridging.
- Bridge only mechanical valves, recent VTE or recent stroke/TIA.
- Do not stop dual antiplatelet therapy unilaterally for recent stents — co-decide with cardiology.
- DOACs act fast and resume quickly without bridging.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | Warfarin bridging |
|---|
→Key pointPerioperative warfarin bridging
- Stop：Stop warfarin ~5 days before surgery (until INR < 1.5)
- Bridging indication：Bridge only if high thrombotic risk: mechanical valve, VTE within 3 months, stroke/TIA within 3 months, rheumatic valve disease; most AF is not bridged
- Bridging method：Therapeutic-dose LMWH, last dose 24 h pre-op (give half the dose)
| View | Antiplatelets |
|---|
→Key pointPerioperative antiplatelets
- Aspirin：Often continued for secondary prevention in minor surgery; stop 5–7 days before high-bleeding-risk surgery
- P2Y12 (clopidogrel/ticagrelor)：Elective: stop 5 (ticagrelor) to 7 days (clopidogrel) pre-op
- Stent patients：Do not stop dual antiplatelet therapy unilaterally for recent stents (especially DES < 6–12 months) — stent thrombosis risk; co-decide with cardiology
Frequently asked questions
- What is Perioperative Anticoagulant/Antiplatelet Bridging?
- Perioperative management of warfarin (bridging), DOACs (interruption/resumption) and antiplatelets, per CHEST 2022/ACC/ASRA. Browser-side reference.
- How is Perioperative Anticoagulant/Antiplatelet Bridging calculated? What is the core formula?
- Warfarin: stop ~5 days pre-op, bridge only if high thrombotic risk. DOAC: stop 1–4 days by drug/renal function/bleeding risk, no bridging.
- When is Perioperative Anticoagulant/Antiplatelet Bridging used?
- Decide whether and how to interrupt and bridge anticoagulation around surgery, balancing bleeding against thrombosis.
- What are the key clinical points for Perioperative Anticoagulant/Antiplatelet Bridging?
- Most atrial fibrillation does not need bridging. Bridge only mechanical valves, recent VTE or recent stroke/TIA. Do not stop dual antiplatelet therapy unilaterally for recent stents — co-decide with cardiology. DOACs act fast and resume quickly without bridging.
- What are the limits and cautions when using Perioperative Anticoagulant/Antiplatelet Bridging?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Perioperative Anticoagulant/Antiplatelet Bridging calculated in practice? Can you show a worked example?
- Inputs: View Warfarin bridging → Result: Key point Perioperative warfarin bridging（Stop: Stop warfarin ~5 days before surgery (until INR < 1.5), Bridging indication: Bridge only if high thrombotic risk: mechanical valve, VTE within 3 months, stroke/TIA within 3 months, rheumatic valve disease; most AF is not bridged, Bridging method: Therapeutic-dose LMWH, last dose 24 h pre-op (give half the dose)） Inputs: View Antiplatelets → Result: Key point Perioperative antiplatelets（Aspirin: Often continued for secondary prevention in minor surgery; stop 5–7 days before high-bleeding-risk surgery, P2Y12 (clopidogrel/ticagrelor): Elective: stop 5 (ticagrelor) to 7 days (clopidogrel) pre-op, Stent patients: Do not stop dual antiplatelet therapy unilaterally for recent stents (especially DES < 6–12 months) — stent thrombosis risk; co-decide with cardiology）