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.
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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