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In North America, there are currently more than one million people with mechanical prosthetic heart valves, chronic atrial fibrillation, or a history of venous thromboembolism who are receiving long-term oral anticoagulation therapy with warfarin (Coumadin®). Perioperative management of the chronically anticoagulated patient is challenging, and the medical team should operate between the fine line of hemorrhagic versus thromboembolic complications.
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