Periprocedural “Bridging” of Anticoagulation in Pts with Mechanical Valve(s)
AVR w/o risk factors
d/c warfarin 2–4 d before surg; restart 12–24 h after surg
MVR or AVR w/ risk factors
Preop: d/c warfarin, start UFH (preferred to LMWH) when INR <2 4–6 h preop: d/c UFH; postop: restart UFH & warfarin ASAP JACC 2017;70:253. Procedures include noncardiac surgery, invasive procedures, and major dental work.