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Published on: February 28, 2012
Prevention of perioperative thromboembolism in patients with atrial fibrillation
1Department of Visceral and Transplant Surgery, University Hospital Berne, Inselspital, Berne, Switzerland. guido.beldi@insel.ch
Insights
For atrial fibrillation patients, postoperative unfractionated heparin (UFH) increased bleeding risk without preventing thromboembolism, unlike low molecular weight heparin (LMWH).
Area of Science:
- Cardiology
- Pharmacology
- Surgical Medicine
Background:
- Atrial fibrillation poses a risk for perioperative thromboembolism.
- Effective prophylaxis is crucial for patient safety during surgery.
Purpose of the Study:
- To compare the safety and efficacy of two thromboembolism prophylaxis regimens in atrial fibrillation patients.
- To evaluate low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) regimens.
Main Methods:
- Retrospective review of 14,801 procedures, identifying 1.9% with atrial fibrillation.
- Regimen 1: LMWH (nadroparine) for patients not on oral anticoagulation (n=146).
- Regimen 2: Intravenous UFH for patients on oral anticoagulation pre-surgery (n=136).
Main Results:
- Thromboembolism incidence was 4.6%, with no significant difference between LMWH and UFH regimens (P=0.780).
- Thromboembolism was linked to increased perioperative mortality (OR 9.5, P=0.001).
- Postoperative bleeding rates were significantly higher with UFH (17.6%) compared to LMWH (4.8%, P<0.001).
Conclusions:
- Therapeutic UFH post-surgery in atrial fibrillation patients increases bleeding risk.
- UFH did not reduce thromboembolism risk compared to LMWH.
- LMWH appears to be a safer alternative for thromboembolism prophylaxis in this patient group.
Background:
The aim of this retrospective study was to review the safety and efficacy of two regimens for the prophylaxis of perioperative thromboembolism in patients with atrial fibrillation.
Methods:
From a database of 14 801 procedures, atrial fibrillation occurred in 1.9 per cent of patients. Those not on oral anticoagulation (n = 146) received low molecular weight heparin (LMWH) before and after surgery (nadroparine 40 units per kg). Patients on oral anticoagulation before surgery (n = 136) received intravenous unfractionated heparin (UFH) after surgery at a dose adequate to maintain the thrombin time at a therapeutic level.
Results:
The incidence of perioperative arterial or venous thromboembolism was independent of pre-existing risk factors and occurred in 4.6 per cent of patients, without significant difference between the two regimens (P = 0.780). Logistic regression revealed that thromboembolism was significantly associated with increased perioperative mortality (odds ratio 9.5, (95 per cent confidence interval 2.5 to 35.8); P = 0.001). The rate of postoperative bleeding was 4.8 per cent in patients who had LMWH and 17.6 per cent in those who had UFH (P < 0.001).
Conclusion:
Postoperative anticoagulation with therapeutic UFH in patients with atrial fibrillation was associated with an increased rate of bleeding without reducing the risk of thromboembolism.
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