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Conservative perioperative anticoagulation management in patients with chronic venous thromboembolic disease: a cohort study
Author(s) -
SKEITH L.,
TAYLOR J.,
LAZOLANGNER A.,
KOVACS M. J.
Publication year - 2012
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2012.04907.x
Subject(s) - medicine , warfarin , perioperative , surgery , thrombosis , cohort , low molecular weight heparin , retrospective cohort study , venous thrombosis , incidence (geometry) , conservative management , confidence interval , atrial fibrillation , physics , optics
Summary. Background: Guidelines for perioperative warfarin management in patients with venous thromboembolic disease (VTE) are largely based on expert opinion. Objectives: To assess the effectiveness and safety of a conservative perioperative anticoagulation strategy in patients with VTE on chronic warfarin therapy. Our center uses a conservative bridging approach for chronic VTE patients consisting of withholding warfarin for 5 days preoperatively, with prophylactic low‐molecular‐weight heparin (LMWH) post‐procedure only if patients are admitted to hospital. Patients/Methods: We performed a single‐center retrospective cohort study. During the study period (1997–2011) there were 634 procedures in 416 patients that were reviewed for postoperative outcomes at 30 and 90 days. Results: Of the 634 procedures, 156 procedures (24.6%) were completed as inpatients. Pre‐ and post‐procedure LMWH bridging was used in 15 (2.4%) and 152 (24.0%) of all procedures, respectively. The 30‐day VTE incidence was 0.32% (95% confidence interval [CI] 0.087–1.14), all non‐fatal DVTs. The 30‐day incidence of major and total bleeding events was 1.26% (95% CI 0.64–2.47) and 3.00% (95% CI 1.93–4.63), respectively. The all‐cause mortality rate was 0.32% (95% CI 0.087–1.14) at 30 days; two patients died from arterial thrombosis events. Conclusions: A randomized controlled trial is needed to provide definitive conclusions but a conservative bridging approach appears promising.