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Bleeding and thromboembolic outcomes for patients on oral anticoagulation undergoing elective colon and rectal
Corey W Iqbal1, Robert R Cima, John H Pemberton
1Mayo Clinic Division of Colon and Rectal Surgery, Rochester, MN 55905, USA.
Insights
Managing patients on chronic warfarin anticoagulation during surgery presents challenges. This study found 10% bleeding and 3% thromboembolism risks, with warfarin for cerebrovascular disease increasing clot risk.
Area of Science:
- Gastrointestinal Surgery
- Cardiovascular Medicine
Background:
- Managing patients on chronic oral anticoagulation, such as warfarin, during the perioperative period is complex.
- Elective abdominal surgeries require careful consideration of anticoagulation management to balance bleeding and thrombotic risks.
Purpose of the Study:
- To evaluate the incidence of bleeding complications and thromboembolic events in patients undergoing elective abdominal colon and rectal operations while on chronic warfarin therapy.
- To identify potential risk factors for these complications.
Main Methods:
- A retrospective review of 146 patients on warfarin undergoing 165 elective abdominal procedures between 2000 and 2006.
- Multivariate analysis was used to identify risk factors for bleeding and thromboembolism.
Main Results:
- 10% of patients experienced postoperative bleeding complications, with 3% requiring reoperation.
- 3% of patients suffered a postoperative thromboembolic event.
- Preoperative anticoagulation for cerebrovascular disease was identified as a risk factor for thromboembolism (p = 0.03).
Conclusions:
- Postoperative bleeding and thromboembolism are significant concerns in patients on chronic anticoagulation undergoing major abdominal surgery.
- Patients on warfarin for cerebrovascular disease require vigilant monitoring and appropriate prophylactic measures to mitigate the increased risk of thromboembolic events.
Purpose:
Patients on chronic oral anticoagulation can be challenging to manage in the perioperative period.
Methods:
Review of patients on warfarin undergoing elective abdominal colon and rectal operations at a single institution from 2000 to 2006.
Results:
One forty-six patients underwent 165 abdominal procedures. Mean (±SEM) age was 67 ± 1 years; 59% of patients were men. Median estimated blood loss was 200 ml, and 19% received intraoperative blood products while 19% of patients received a postoperative transfusion. Sixteen patients (10%) experienced bleeding complications (three requiring reoperation). No risk factors for bleeding were identified by multivariate analysis (MVA). Five patients (3%) suffered a postoperative thromboembolic event. Preoperative anticoagulation for cerebrovascular disease was a risk factor for thromboembolism (p = 0.03). Overall operative morbidity was 30% with no identifiable risk factor in MVA. Mortality was nil.
Conclusion:
Postoperative bleeding and thromboembolism in patients on chronic anticoagulation are not insignificant (10% and 3%, respectively). Patients on warfarin for cerebrovascular disease are at increased risk for thromboembolic events postoperatively and should be placed on appropriate prophylaxis and monitored.
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