Heparin and Warfarin - Sydney South West Area Health Service

THE DAY OF SURGERY:
Last Clexane to be taken 18-24 hrs pre-operatively for therapeutic dose and >12 hours
for a prophylactic dose with normal renal function.
INR on day of surgery should be ≤ 1.5 or ≤ 1.2 in high bleeding risk surgery
0
Date Day **WARFARIN **ENOXAPARIN ≥ 6-12 hrs
post-op
** The risk of bleeding in the immediate post-op outweighs the risk of thrombosis. Do not restart
anticoagulation (unless extremely high risk of thrombosis) until instruction from the surgeon.
It is the responsibility of the surgical team to reassess the bleeding risk post surgery and to
seek further consultant advice in the event of a change in the clinical circumstances.
Warfarin dose is the patient’s regular dose. No loading.
POST-OPERATIVE:
+1
Date Day WARFARIN ENOXAPARIN DOSE &
FREQUENCY
+2
+3
+4
+5
Check the following every 24-48 hours as indicated
• INR
• FBC
• anti-Xa in patients on Enoxaparin who have significant renal impairment (GFR < 60
ml/min)
• LFTs, Albumin and Creatinine (twice weekly as indicated)
See intravenous heparin protocol for patients on unfractionated heparin.
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