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Med Clin (Barc). 2017 Oct 11;149(7):281-286. doi: 10.1016/j.medcli.2017.01.023. Epub 2017 Mar 7.

Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience.

[Article in English, Spanish]

Author information

1
Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. Electronic address: anaflorenciabecerra@yahoo.com.ar.
2
Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
3
Servicio de Cardiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
4
Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
5
Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina; Servicio de Medicina Vascular y Trombosis, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.

Abstract

BACKGROUND AND OBJECTIVES:

To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery.

MATERIAL AND METHODS:

A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it.

RESULTS:

A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal).

CONCLUSIONS:

Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events.

KEYWORDS:

Antagonistas de vitamina K; Anticoagulación; Anticoagulation; Atrial fibrillation; Embolia; Embolism; Fibrilación auricular; Perioperative management; Perioperatorio; Thrombosis; Trombosis; Vitamin K antagonists

PMID:
28283268
DOI:
10.1016/j.medcli.2017.01.023
[Indexed for MEDLINE]

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