Stop oral anticoagulants at least 5 days preoperatively, and do not perform the procedure until the PT is in the reference range. Coumadin is restarted as soon as tolerated by the patient. Heparin is discontinued 6-12 hours before surgery and restarted at 200-400 U/h at 4-6 hours after surgery. How long does it take to bridge heparin with warfarin?īridging anticoagulation refers to giving a short-acting blood thinner, usually low-molecular-weight heparin given by subcutaneous injection for 10 to 12 days around the time of the surgery/procedure, when warfarin is interrupted and its anticoagulant effect is outside a therapeutic range. In order to shorten the response time for making a dosing change, patients are traditionally advised to have their INR test in the morning and to take their warfarin in the evening (so that the INR test result will be back in time to change that day’s warfarin dose if needed). Little information exists regarding the benefit of bridging warfarin among patients with atrial fibrillation. Do you always have to bridge warfarin with heparin?īridging to Warfarin with Heparin in Atrial Fibrillation Isn’t Necessary, May Be Harmful. Heparin should be continued until the INR has been ≥ 2 for at least two consecutive days or for five days – whichever is the longer. Warfarin can be started as soon as the diagnosis is confirmed.
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