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Internal Medicine


Answer 4
  1. Stop warfarin therapy 5 days before surgery, admit the patient to receive heparin intravenously 3 days prior to surgery, stop heparin 12 hours prior to surgery, and restart heparin and warfarin therapy following surgery. Because of a prior embolic event, this patient is at high risk for thrombotic complications if anticoagulation therapy is withdrawn. Because of this risk, management with heparin and warfarin is the correct strategy. Canceling the surgery deprives the patient of a potentially curative procedure. Continuing warfarin through the perioperative period significantly increases the patient’s risk of bleeding. Many authorities feel that stopping warfarin without using heparin in high-risk patients is insufficient. Aspirin is not an adequate substitute for anticoagulation therapy.

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