Ahmed El-Bardissy

Introduction The perioperative management of patients receiving vitamin K antagonist (VKA) therapy is a common clinical dilemma. VKA regimens can be continued, interrupted, or replaced with other parenteral anticoagulants (ACs), namely “bridging.”1 The issue is always complicated with the small overlapping line between thrombotic and bleeding risks. An initial consideration is to avoid or delay the procedure until the VKA administration is no longer required, if at all possible.

Introduction Warfarin, which is a vitamin-K antagonist (VKA), has been the mainstay oral anticoagulant (OAC) used in both treatment and prevention of various thromboembolic disorders for more than 7 decades.1 Warfarin has a wide range of food and drug interactions, unpredictable pharmacokinetics, narrow therapeutic index, and inter- and intra-patient variability.