Disadvantages of perioperative heparin bridging:
a) Risk of thromboembolism due to subtherapeutic dose
b) More prolonged total hospital stay
c) Cost and inconvenience of heparin therapy
d) All of the above
Correct answer: d) All of the above
In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anaesthesia in one such potential situation in which the bleeding risk is very low. Ablation of atrial fibrillation is a situation in which the thrombotic risk is high.