!AFib - Atrial Fibrillation + need surgery
| Situation | Hold on which day | Restart (< x hr post-op) | |
|---|---|---|---|
| ‣ | Low risk of bleeding | -1 day (x2 for renal dysfunction) | < 24 hr (POD1) |
| ‣ | High risk of bleeding | -2 days (x2 for renal dysfunction) | < 48 hr (POD2) |
| ‣ (VKA) | Low risk condition | -5 days-→ -1 day check INR, ‣ if INR > 1.5 | < 24 hr (POD1) |
| Warfarin → Bridging with LMWH or ‣ | High risk condition (valvular AF, mechanical valve, etc.) | -5 days stop warfarin → -3 days start LMWH → -1 day check INR + 1/2 dose LMWH | < 24 hr (POD1) |
72 hr (cardiac surgery) |
