Algorithm of Dunn for the Perioperative Management of a Patient Receiving Oral Anticoagulation

Purpose: To manage a patient who is taking an oral anticoagulant and who is undergoing surgery based on the protocol of Dunn.

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Evaluation

Are you evaluating a patient who is taking an oral anticoagulant prior to surgery?

Yes

Is the patient strongly in favor of bridging?

Yes

Are there good indications to continue bridging with heparin after surgery?

Yes

Select an appropriate answer for each finding

Patient's risk of stroke

Risk of bleeding from the procedure

Results

Please fill out required fields.

Results Interpretation and Description References Next Steps

Data complete?

Evaluation appropriate?

Should the patient undergo preoperative bridging?

Should the patient undergo postoperative bridging if there is no excessive bleeding after the surgery?

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Interpretation and Description

References

Next Steps in Evaluation

Diagnosis

Risk Factors
- Risk Factors of Hylek et al for Excessive Warfarin Anticoagulation
Clinical Diagnosis, Including Family History For Genetics
- Warfarin (Coumadin) Resistance Testing
- Warfarin Resistance Associated with Poor Intestinal Absorption
Laboratory Tests
- Warfarin (Coumadin) Resistance Testing

Therapy

Pharmacogenetics
- Regression Model of Wells et al for Predicting Warfarin Dose Using Pharmacogenetics
Drug Interactions
- Daily Warfarin Dosage Adjustment for Patient Receiving Long-Term Amiodarone Therapy
Dosage Calculations
Dosage Adjustments
Failure Handling And Therapy Escalation

Monitoring

Response To Therapy
- Warfarin (Coumadin) Resistance Testing
Adverse Effects
- Risk Factors of Hylek et al for Excessive Warfarin Anticoagulation
Drug Levels
- Warfarin (Coumadin) Resistance Testing
Overdose And Reversal
- Warfarin (Coumadin) Resistance Testing
- Risk Factors of Hylek et al for Excessive Warfarin Anticoagulation

Specialty

Hematology Oncology
Clinical Laboratory
Pharmacology, clinical

Objective

risk factors
selection

ICD-10

I74 - Arterial embolism and thrombosis
I81 - Portal vein thrombosis
I82 - Other venous embolism and thrombosis
O88 - Obstetric embolism
T79.0 - Air embolism (traumatic)
T79.1 - Fat embolism (traumatic)

Info

Purpose: To manage a patient who is taking an oral anticoagulant and who is undergoing surgery based on the protocol of Dunn.

Specialty: Hematology Oncology, Clinical Laboratory, Pharmacology, clinical

Objective: risk factors, selection

ICD-10: I74, I81, I82, O88, T79.0, T79.1,

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