Inguinal hernia repair in the anticoagulated patient: a retrospective analysis

Guidelines and local hospital protocols dealing with anticoagulation at the time of surgery vary, but most suggest stopping Warfarin at least three days preoperatively with or without interim low-molecular-weight heparin or intravenous heparin infusion. This study addresses whether it is safe to perform inguinal hernia surgery on the patient who is fully anticoagulated with Warfarin.

We performed a retrospective case note analysis of consecutive patients who underwent elective inguinal hernia repair at the Plymouth Hernia Service between 1999 and 2007. All patients on therapeutic oral anticoagulation with Warfarin were selected. Data analysis was of complications and patient-related, hernia-related, and surgery-related variables. International normalising ratio (INR) was measured on the day preceding surgery.

A total of 49 patients had been operated on whilst anticoagulated with Warfarin. The mean age of the patients was 75 years (range 44-96 years). Thirty patients were on Warfarin for atrial fibrillation, seven for previous PE, three for previous DVT, and nine for mechanical heart valves. Forty patients had a desired INR range of 2-3, and nine a desired range of 3-4. Forty-five (91.8%) patients had no complications or mild bruising requiring no further management. Three (6.1%) patients developed haematomas requiring surgical management and there was one death of unrelated cause. An INR of greater than 3 increased the risk of postoperative haematoma (P = 0.03). None of the other measured patient-related, hernia-related, or surgery-related variables predicted complications (P > 0.05).

Patients can safely undergo inguinal hernia repair whilst on Warfarin as long as the INR is less than 3.