GP CCE Cases · haematological-presentations
Anticoagulated for surgery — CCE clinical encounter
CCE-style clinical encounter: a 68-year-old man with AF on rivaroxaban is listed for elective hernia repair. The candidate must plan the interruption window, refuse reflex bridging with BRIDGE evidence, and set restart timing and renal monitoring.
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Prompt
A 68-year-old man attends for pre-operative review before elective right inguinal hernia repair in three weeks. He takes rivaroxaban 20 mg daily for AF (CHA2DS2-VASc 2), no prior stroke, eGFR 58 mL/min/1.73 m². The surgical letter asks the GP to 'manage anticoagulation'. He has heard he will need 'clexane in the belly'.
Objectives
- Set the rivaroxaban interruption window correctly (48–72 hours pre-op at his eGFR). [1]
- Refuse reflex LMWH bridging using BRIDGE trial numbers — bleeding tripled without benefit. [1]
- Plan warfarin-free alternatives correctly if switching were ever considered (five-day rule). [1]
- Arrange post-op restart within 24–72 hours per surgical bleed risk. [1]
- Safety-net for perioperative stroke symptoms and book renal function check. [1]
References1ShowHide
- [1]Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation (BRIDGE) N Engl J Med, 2015.PMID 26095867