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Published on: February 28, 2012
Anticoagulation management in the ambulatory surgical setting
1Cooper University Hospital, Camden, NJ, USA.
Insights
Managing anticoagulation therapy for surgery is complex. Nurse practitioner involvement may improve adherence to guidelines and enhance patient safety in ambulatory surgery centers.
Area of Science:
- Medical Science
- Pharmacology
- Patient Safety
Background:
- Anticoagulation therapy is common for patients undergoing procedures in ambulatory surgery centers.
- Current guidelines exist for managing anticoagulation during surgery to balance thromboembolism and bleeding risks.
- Adherence to established anticoagulation management guidelines is suboptimal.
Purpose of the Study:
- To evaluate the adherence to anticoagulation management guidelines in ambulatory surgery.
- To explore the potential role of nurse practitioners in improving anticoagulation management and patient safety.
Main Methods:
- Literature review of current anticoagulation management guidelines.
- Analysis of adherence to recommendations for bridging therapy and warfarin continuation.
- Discussion of the impact of nurse practitioner management on compliance and safety.
Main Results:
- Existing literature indicates inadequate adherence to American College of Chest Physicians guidelines for anticoagulation management.
- Warfarin discontinuation and bridging strategies (low-molecular-weight heparin or unfractionated heparin) are not consistently applied.
- Continuation of warfarin for minor procedures is also inconsistently managed.
Conclusions:
- Suboptimal adherence to anticoagulation management guidelines poses a risk to patients undergoing surgery.
- Nurse practitioner-led management of anticoagulation therapy may offer a solution to improve compliance and safety.
- Implementing standardized protocols and potentially advanced practice provider involvement can enhance perioperative anticoagulation care.
Abstract:
Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.
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