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Neda K.: When to Hold Antithrombotics and Use Bridging Therapy in Surgery
Neda K./LinkedIn
Apr 23, 2026, 16:55

Neda K.: When to Hold Antithrombotics and Use Bridging Therapy in Surgery

Neda K., Clinical Pharmacist, shared a post on LinkedIn:

”Perioperative Management of Antithrombotic: When to Hold Therapy

Perioperative management of antithrombotic therapy is all about balancing bleeding and thrombotic risks. The holding times for each agent are outlined in the image below.

Bridging Therapy: Who Really Needs It?

Indications for bridging when interrupting vitamin K antagonists:

Consider only in high thrombotic risk, such as:

  • Mechanical heart valves
  • Recent venous thromboembolism (VTE) (less than 3 months)
  • Very high-risk atrial fibrillation

How to bridge?

  • Discontinue warfarin 5 days before surgery.
  • Start LMWH or UFH at therapeutic doses 3 days before surgery.
  • Discontinue LMWH 24 hours or UFH 4 to 6 hours before surgery.”

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Antithrombotics bleeding disorders Health Hematology Hemostasis Hemostasis News Hemostasis Today LMWH Medicine Neda K. thrombosis UFH VTE
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