Practice Quiz

CMC Cardiac Medicine Certification

Category - CMC

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A 45-year old female patient is on warfarin therapy for atrial fibrillation. She has planned to undergo mitral valve replacement surgery for mitral stenosis and mitral regurgitation. What advice should be given by the nurse regarding the anticoagulant medication?
  1. Stop warfarin on the day of surgery
  2. Stop warfarin 4-5 days before surgery
  3. Stop warfarin 4-5 days prior to surgery; admit and start on IV heparin; stop IV heparin 2-3 hours pre-op
  4. Continue warfarin therapy
Explanation
Answer- C - The advice for patients taking anticoagulants like warfarin is to stop 4-5 days prior to surgery; admit and start on IV heparin if high risk of thrombosis (large left atrium, atrial fibrillation, mitral valve prosthesis). IV heparin should be stopped 2-3 hours preoperation (unless on intra-aortic balloon pump (IABP) support).
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