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Atrial Fibrillation: Managing Your Anticoagulant Medication Before Surgery
Published: May 04, 2024
If you have atrial fibrillation and take blood thinners, managing your medication before surgery is crucial. Balancing the risks of bleeding and blood clots requires careful planning.
Understanding the Risks
Stopping your blood thinner increases the risk of blood clots, while continuing it raises bleeding risk during surgery. Your doctor will assess your individual risks based on factors like age, other health conditions, and type of surgery. For example, someone who recently had a stroke is at higher risk of blood clots if they stop their medication.
Timing Is Everything
How long to stop your medication before surgery depends on which blood thinner you take. Warfarin is usually stopped 5 days before surgery. Newer medications like apixaban or rivaroxaban can often be stopped just 1-2 days before. Your doctor will give you specific instructions.
Bridging Therapy
Some high-risk patients may need 'bridging therapy' - using short-acting blood thinners like heparin injections when you stop your usual medication. This helps prevent blood clots in the days before surgery. However, bridging isn't needed for most patients and can increase bleeding risk.
After Surgery
Your doctor will let you know when it's safe to restart your blood thinner after surgery, usually within 24-72 hours. The exact timing depends on your bleeding risk. You may receive low doses of blood thinners to prevent blood clots until you can restart your full dose.
Frequently Asked Questions
For most patients, brief interruption is low-risk if managed properly.
Most patients don't need bridging, but some high-risk cases may.
Usually within 1-3 days after surgery if bleeding is controlled.
Special reversal agents may be used to quickly stop anticoagulant effects.
The risk is low if medication is managed properly around surgery.
The Bottom Line
Careful planning helps minimize risks when managing blood thinners before surgery.
References
- Douketis JD et al. Chest. 2012;141(2):e326S-e350S.
- Spyropoulos AC et al. Blood. 2012;120(15):2954-2962.
- Healey JS et al. Circulation. 2012;126(3):343-348.
This article has been reviewed for accuracy by one of the licensed medical doctors working for Doctronic. Always discuss health information with your healthcare provider.
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