cirus
Forum Guru
Topics: 108
Posts: 740
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A 78-year-old woman is scheduled for a right nephrectomy for renal cell cancer. She underwent aortic and mitral valve replacement 12 years ago with St. Jude Medical bileaflet mechanical prostheses for rheumatic valvular disease. She has no other significant medical history. Her only medications are warfarin (with a target INR of 2.5 to 3.5) and antibiotic prophylaxis for endocarditis.
Which of the following is the best plan for anticoagulation in the perioperative period?
( A ) Maintain the INR between 2.5 and 3.5 throughout the perioperative period.
( B ) Stop the warfarin 3 to 5 days before surgery and restart it 1 to 3 days after surgery.
( C ) Stop the warfarin 3 to 5 days before surgery and start heparin 3 days before surgery and again 1 day after surgery.
( D ) Maintain the INR between 1.5 and 2.5 throughout the perioperative period and begin the usual dose of warfarin 5 days after surgery.
( E ) Continue warfarin up to the day of surgery; administer vitamin K, 1 mg intravenously on the morning of surgery, and start heparin 1 day after surgery.
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| hanwin
Forum Senior
Topics: 6
Posts: 157
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Good Q.
He is hish risk therefore need bridging therapy.
C is the best.
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