🌉 Perioperative Anticoagulant/Antiplatelet Bridging
Perioperative management of warfarin (bridging), DOACs (interruption/resumption) and antiplatelets, per CHEST 2022/ACC/ASRA. Browser-side reference.
Perioperative Anticoagulant/Antiplatelet 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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.