Conservative perioperative anticoagulation management in patients with chronic venous thromboembolic disease: a cohort study
Article first published online: 30 OCT 2012
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 10, Issue 11, pages 2298–2304, November 2012
How to Cite
SKEITH, L., TAYLOR, J., LAZO-LANGNER, A. and KOVACS, M. J. (2012), Conservative perioperative anticoagulation management in patients with chronic venous thromboembolic disease: a cohort study. Journal of Thrombosis and Haemostasis, 10: 2298–2304. doi: 10.1111/j.1538-7836.2012.04907.x
- Issue published online: 30 OCT 2012
- Article first published online: 30 OCT 2012
- Accepted manuscript online: 24 AUG 2012 09:41AM EST
- Received 23 June 2012, accepted 17 August 2012
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.