A 52-year-old woman on ICU requires emergency surgery for a perforated duodenal ulcer. She is receiving IV unfractionated heparin for a recently diagn...

Question

A 52-year-old woman on ICU requires emergency surgery for a perforated duodenal ulcer. She is receiving IV unfractionated heparin for a recently diagnosed submassive PE (diagnosed 3 days ago). The surgical team requests that heparin be stopped perioperatively. What is the approach to perioperative anticoagulation management?

Accepted Answer

Stop heparin 4-6 hours before surgery (UFH half-life ~60-90 minutes), perform surgery, and restart heparin as soon as surgically safe (typically 12-24 hours post-operatively if there is no active bleeding) - with close liaison between surgical, haematological, and ICU teams regarding the competing risks of bleeding and PE extension

Answer

Continue heparin during surgery

Answer

Stop heparin permanently

Answer

Insert an IVC filter and never restart anticoagulation

Answer

The surgery cannot be performed while on heparin

uk-fficm MCQ (SBA): Perioperative Anticoagulation - PE