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Recommendations for preoperative and postoperative anticoagulation in patients on a vitamin K antagonist

Indication	Before surgery	After surgery
Venous thromboembolism
Within first month	IV heparin or SQ LMWH	IV heparin or SQ LMWH
Second/third month	No change*	IV heparin or SQ LMWH
≥3 months	No change*	SQ heparin or LWMH
Arterial thromboembolism
Recent, within one month	IV heparin or SQ LMWH	IV heparin or SQ LMWH
Prophylaxis (eg, non-valvular AF, mechanical heart valve)	No change*	Resume oral anticoagulation^¶

NOTE: Warfarin should be withheld to allow the INR to fall spontaneously to 1.5 to 2 before surgery is performed.

IV: intravenous; SQ: subcutaneous; LMWH: low molecular weight heparin; AF: atrial fibrillation; INR: international normalized ratio.
* If the patient is hospitalized, SQ heparin or LMWH should be administered, but hospitalization is not recommended solely for this purpose.
¶ Can use SQ heparin or SQ LMWH if the surgery carries a high risk of postoperative thromboembolism.

Graphic 81389 Version 4.0