warfarin standard risk

Preoperative

• Withhold warfarin 5 days prior to surgery.

• No bridging required.

• Day before surgery; if INR is >1.5 give vitamin K 1-2mg orally.

• Morning of surgery; if INR >1.5 defer sugery or if urgent consider Prothrombinex / Beriplex plus FFP (1 unit, 275ml). Discuss with haematology.

Postoperative

• Restart on the night of surgery, at the previous maintenance dose, only if there is no evidince of significant haemorrhage.