Open AccessThe effect of stopping phenprocoumon 5 days preoperatively: A retrospective study
Author(s) -
Knol Silke,
Mallo Mascha,
Tromp Meesters Reinier,
Westerink Jan,
Ree Marcel
Publication year - 2019
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12159
Subject(s) - phenprocoumon , medicine , discontinuation , vitamin k antagonist , odds ratio , retrospective cohort study , confidence interval , surgery , vitamin k , warfarin , atrial fibrillation
Background Clinicians lack substantiated guidance on when vitamin K antagonist ( VKA ) treatment should be interrupted preoperatively, especially with regard to phenprocoumon, with its long half‐life of 5.5 days. Objective To evaluate the efficacy of discontinuing phenprocoumon 5 days preoperatively and determine whether a safe international normalized ratio ( INR ) was reached. Methods This was a retrospective review of 118 patients using phenprocoumon prior to elective surgery. Preoperative INR s and factors that could potentially influence these values were identified and described. A safe preoperative INR was defined as <1.8. Results Of the 118 included patients, 42 patients (35.6%) had an off‐target INR . The male sex was significantly and independently associated with an off‐target INR (odds ratio [ OR ] 2.4, 95% confidence interval [ CI ] 1.022‐5.445). A high American Society of Anesthesiologists ( ASA ) classification was also significantly and independently associated with an off‐target INR ( OR 2.3, 95% CI : 1.029‐5.173). Conclusion Discontinuation of phenprocoumon 5 days preoperatively resulted in an INR < 1.8 in more than one‐third of patients. Individualizing or extending the period of phenprocoumon discontinuation may be a necessary treatment option.