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Conservative perioperative anticoagulation management in patients with chronic venous thromboembolic disease: a

L Skeith1, J Taylor, A Lazo-Langner

  • 1Department of Medicine, Division of Hematology, London Health Sciences Centre, London, ON Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.

Journal of Thrombosis and Haemostasis : JTH
|August 29, 2012
PubMed

Insights

A conservative perioperative anticoagulation strategy using warfarin and low-molecular-weight heparin (LMWH) showed promising results for venous thromboembolic disease (VTE) patients, with low 30-day VTE incidence and bleeding events.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pharmacology

Background:

  • Current guidelines for perioperative warfarin management in venous thromboembolic disease (VTE) lack robust evidence.
  • Management strategies are primarily based on expert opinion.

Purpose of the Study:

  • To evaluate the effectiveness and safety of a conservative perioperative anticoagulation strategy.
  • To assess outcomes in patients with VTE on chronic warfarin therapy using a specific bridging approach.

Main Methods:

  • Single-center retrospective cohort study of 634 procedures in 416 patients (1997-2011).
  • Conservative bridging involved withholding warfarin for 5 days preoperatively.
  • Prophylactic low-molecular-weight heparin (LMWH) was administered post-procedure only for hospitalized patients.

Main Results:

  • Low 30-day incidence of VTE (0.32%), with all events being non-fatal deep vein thromboses (DVTs).
  • 30-day incidence of major bleeding was 1.26% and total bleeding was 3.00%.
  • All-cause mortality at 30 days was 0.32%, with two deaths attributed to arterial thrombosis.

Conclusions:

  • A conservative bridging approach using warfarin and LMWH appears promising for VTE patients.
  • Further investigation via a randomized controlled trial is recommended for definitive conclusions.
Abstract

Keywords:
anticoagulantssurgerythrombosis

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