how to transformation to heparine/LMWH regimens within patients taking warfarine during surgery? thank you?

eg; patient next to permanent atrial fibrillation unloading warfarine (INR at about 2,7) desires to undergo surgery for gastric cancer? What heparine should he use, what dose and when can he progress back to the previous warfarine treatment? There is no unqualified answer to this. You have to use your clinical judgement to weigh the risks of stroke vs. bleeding out. Generally individuals try to avoid anticoagulation during surgery (stop warfarin a few days prior, stop anti-platelet agents a week prior). If the person is at such dignified thromboembolic risk that you decide to anticoagulate perioperatively, you'll still want to stop the warfarin--you'll use IV heparin instead (because it can be reversed hastily, if needed). Post-operatively, if you held off on the heparin during the surgery, you can start it (or use LMWH) more or less 12 hours later. The warfarin can be restarted surrounded by a couple of days (after the PTT is therapeutic).

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