Perioperative Management of Long-Term Warfarin Anticoagulated Patients (Focused on Outpatient Bridging with Low Molecular Weight Heparins)
Management of patients under chronic coumadin anticoagulation on the perioperative setting is a frequent and problematic clinical scenario. Temporary interruption of anticoagulation during surgical procedures places the patients at risk of thrombo-embolic events and on the other hand, keeping antico...
| Autor Principal: | Alvarado Arteaga, Iván Mauricio; Hospital Universitario San Ignacio |
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| Formato: | info:eu-repo/semantics/article |
| Idioma: | spa |
| Publicado: |
Pontificia Universidad Javeriana
2012
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| Materias: | |
| Acceso en línea: |
http://revistas.javeriana.edu.co/index.php/vnimedica/article/view/16142 |
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| Sumario: |
Management of patients under chronic coumadin anticoagulation on the perioperative setting is a frequent and problematic clinical scenario. Temporary interruption of anticoagulation during surgical procedures places the patients at risk of thrombo-embolic events and on the other hand, keeping anticoagulation throughout surgery puts them at risk of bleeding complications. There is limited evidence in this topic and clinical guidelines based on expert opinion are inconsistent. The lack of clear guidelines and the indiscriminate use of unfractionated heparin for transitional replacement generate delays, extra costs and is cause of unnecessary days of hospitalization. This text discusses the possible variables and risks to consider in decision making and also the evidence in regards to low molecular weight heparins for transitional and perioperative outpatient replacement of anticoagulation called “bridging”. A practical guideline and a simple algorithm are proposed in order to facilitate its implementation. |
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