Hematology Experience with Perioperative Anticoagulation at a Tertiary Hospital

The purpose of our study was to evaluate the peri-procedure management of patients on chronic vitamin K antagonists (VKA) and to assess adherence to the 2008 American College of Chest Physicians (ACCP) guidelines.

We retrospectively reviewed the electronic medical records of patients on chronic VKA who required temporary discontinuation of anticoagulation due to an invasive or surgical procedure at New York Presbyterian Hospital from January 2006 to June 2010. Dermatological or oral procedures were excluded. Demographics, indications of VKA, underlying thrombophilia, cancer or inflammatory bowel disease, type of invasive or surgical procedure, method of bridge therapy and complications were recorded. When the ACCP guidelines were published, we compared our previous practice and modified our management accordingly.

A total of 48 procedures where performed in 34 patients. The demographic and clinical characteristics of these patients are shown in Table 1. The type of procedure, anticoagulant bridge therapy and complications are shown in Table 2. The majority of the procedures were managed using bridge therapy with low molecular heparin (LMWH) treatment dose. There were no thrombotic episodes, however there were 3 bleeding complications. All occurred prior to the publication of the 2008 ACCP guidelines. The patients who had bleeding complications were on therapeutic dose LMWH/Fondaparinux bridge therapy. One patient with the antiphospholipid syndrome developed severe thrombocytopenia after surgery that responded to intravenous gamma globulin.

Adherence to the ACCP guidelines for the perioperative management of anticoagulation minimizes bleeding complications and improves patient outcomes.

No relevant conflicts of interest to declare.