FRCPath Haem Part 1 EMQs-Haemostasis 59 and 60

Theme: Perioperative Anticoagulation

Options

A. Continue warfarin without interruption

B. Stop warfarin 5 days pre-op, no bridging

C. Stop warfarin 5 days pre-op + therapeutic LMWH bridging

D. Stop warfarin 5 days pre-op + prophylactic LMWH

E. Continue DOAC without interruption

F. Stop DOAC 24 hours pre-op

G. Stop DOAC 48–72 hours pre-op

H. Delay surgery

I. Warfarin reversal by PCC and Vitamin K

J. Restart anticoagulation 6–12 hours post-op at therapeutic dose

Questions

Q1

A 68-year-old man with non-valvular AF, CHA₂DS₂-VASc = 2, on warfarin, is scheduled for elective inguinal hernia repair.

Q2

A 75-year-old woman with mechanical mitral valve on warfarin requires emergency hip fracture surgery.

Q3

A 60-year-old man with AF on apixaban, normal renal function, undergoing colonoscopy with polypectomy.

Q4

A 72-year-old woman with recent VTE (3 weeks ago) on warfarin requires elective cholecystectomy.

Q5

A 66-year-old man with AF on rivaroxaban, CrCl 25 mL/min, scheduled for major abdominal surgery.

Q6

A 55-year-old woman on warfarin for AF, CHA₂DS₂-VASc = 1, undergoing cataract surgery.

Q7

A 70-year-old man with mechanical aortic valve on warfarin undergoing elective knee replacement.

Q8

A 64-year-old woman on dabigatran, normal renal function, undergoing high bleeding risk neurosurgery.

Q9

A 58-year-old man on warfarin for unprovoked VTE 5 years ago, now scheduled for minor dermatological excision.

Q10

A 77-year-old woman on warfarin for AF undergoes major surgery. Haemostasis is secure post-op. When should therapeutic anticoagulation be restarted?