You know that sometimes the only needed action is to stop the warfarin (Coumadin) several days before the surgery
Other times, the provider initiates "bridging therapy," or stops the warfarin and provides anticoagulation
protection by initiating low-molecular-weight heparin. After reviewing all of his anticoagulation
information, the provider decides that K.N. will need to stop the warfarin (Coumadin) 1 week before
the surgery and in its place be started on enoxaparin (Lovenox) therapy.
Compare the duration of action of warfarin (Coumadin) and enoxaparin (Lovenox) and explain the reason the provider switched to enoxaparin at this time.
Warfarin has a duration of 2 to 5 days; enoxaparin has a duration of 12 hours. K.N. is still at risk for
thrombus formation because of the atrial fibrillation. Yet he needs to have the knee surgery, and it
would be risky to perform the knee surgery while K.N. is anticoagulated with warfarin—there would
be a risk of excessive bleeding during and after the surgery. Therefore, the warfarin is discontinued
in advance of the surgery because it will take several days for the anticoagulation effects to wear off.
However, the enoxaparin can still be given at this time to provide needed levels of anticoagulation.
It will be stopped just before the surgery because of its shorter duration. The goal is to have him off
oral anticoagulation for a minimum amount of time to prevent the possible risk of a clot formation
and potential stroke. His provider will monitor him closely before and after surgery.
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