Reversal of warfarin anticoagulation for urgent surgical procedures

Patients treated with warfarin for therapeutic anticoagulation present a challenge for the perioperative management of urgent and emergent surgery. Anticoagulation must be reversed prior to most surgical procedures to prevent intraoperative bleeding. The purpose of this module is to review the options for urgent reversal of warfarin anticoagulation and the indications for each reversal agent. Selection of the appropriate agent is important to reduce unnecessary complications of treatment and to achieve optimal reversal of anticoagulation.

Objectives of this Continuing Professional Development (CPD) module:

After reading this module, the reader should be able to:

  1. Identify the options for emergency reversal of warfarin anticoagulation;
  2. Describe the dose, onset, and duration of action of agents that reverse warfarin anticoagulation;
  3. List potential complications and contraindications of agents that reverse warfarin anticoagulation;
  4. Choose the optimal agent for emergency reversal of warfarin anticoagulation, considering the timing of the operation and the risks and benefits of each agent.

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