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# Warfarin
- URL: https://www.preanaesthesia.com/clinician-reference/warfarin/
- Published: 2026-09-13T04:54:38.000Z
- Updated: 2026-09-13T19:19:44.000Z
- Description: Review interruption, bridging considerations and restart planning in the context of bleeding and thromboembolic risk.
- Author: preetam satish
- Tags: #clinician, #Import 2026-09-12 18:04

Warfarin management requires a procedure-specific assessment of bleeding and thromboembolic risk.

## Interruption and bridging

When warfarin interruption is required, CHEST 2022 suggests stopping warfarin at least 5 days before the procedure. Bridging is not routine and CHEST recommends/suggests against heparin bridging in several common indications, including atrial fibrillation and many patients with mechanical valves or VTE. Procedure-specific and thromboembolic risk assessment remains essential.

The indication, INR and procedure-specific bleeding risk inform the individual plan. Very high thrombotic-risk situations require specialist planning; CHEST and cardiovascular guidance should be interpreted in their respective clinical contexts. Planning includes the timing of restarting treatment as well as any interruption.

## Sources

- [CHEST 2022 antithrombotic guideline](https://www.chestnet.org/guidelines-and-topic-collections/guidelines/pulmonary-vascular/perioperative-management-of-antithrombotic-therapy)
- [2024 AHA/ACC perioperative cardiovascular guideline](https://professional.heart.org/en/science-news/2024-guideline-for-perioperative-cardiovascular-management-for-noncardiac-surgery)

## Related reading

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- [ACE inhibitors / ARBs / RAAS inhibitors](https://www.preanaesthesia.com/clinician-reference/ace-inhibitors-arbs-raas-inhibitors/)
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