Question

A 58-year-old with a mechanical mitral valve on warfarin (INR goal 2.5-3.5) is scheduled for major abdominal surgery. What is the recommended periprocedural anticoagulation plan?

Accepted Answer

Bridge with therapeutic‑dose LMWH when INR falls subtherapeutic, and stop LMWH ~24 hours pre‑op

Answer

Stop warfarin 5 days prior without bridging

Answer

Switch to a DOAC 3 days pre‑op

Answer

Continue warfarin through surgery with INR near 3.0

Answer

Use prophylactic‑dose LMWH as bridge

Practice question

A 58-year-old with a mechanical mitral valve on warfarin (INR goal 2.5-3.5) is scheduled for major abdominal surgery. What is the recommended periprocedural anticoagulation plan?