Abstract
The perioperative management of patients on long term OAT is an open issue. The problem is the prevention of both the thromboembolic (TE) and the hemorrhagic complications. The therapeutic options are: 1) discontinuation of OAT with an INR target <2.0 at the scheduled time and its resumption after surgery, 2) substitution of OAT with low molecular weight heparin (LMWH) in the perioperative period. We report on 477 consecutive patients who underwent elective surgery in 7 FCSA centers (November 2001 to August 2003). Major and minor surgery and other minor procedures were carried out in 68, 206 and 203 patients respectively; median age 72 years (25–97); 279 males, 198 females. The aim of the study was to evaluate the complications occurring during and within 2 months after surgery with the different modalities of prophylaxis. Indications for OAT./bold]Low and intermediate TE risk patients:secondary prophylaxis of venous thrombosis (VT) 75; non valvular atrial fibrillation (AF) 225; aortic mechanical or biological valves 58, dilatative myocardiopathy 8, valvulopathy 10; myocardial infarction 3; coronary artery by-pass graft 4; stroke 4.High TE risk patients: mitral mechanical valve, mechanical valves + AF or previous TE 53, AF + ≥2 other risk factors (arterial hypertension, dilatative myocardiopathy, previous TE, biological heart valve) 6; intracardiac thrombosis 1.
Results: LMWH therapy: Nadroparin (Seleparina®) and enoxaparin (Clexane®) in 394 and 28 patients respectively. Comments . One patients with high thromboembolic risk died because of sudden cardiac arrest 13 days after a procedure. TE events (0.6%) occurred in 2 patients with mechanical aortic valve and valvulopathy respectively and treated with s.i.d dose. Incidence of major bleeding is higher in patients treated with LMWH b.i.d but it is in accordance with the data reported in the literature.
Table I
Therapy no OAT LMWH (s.i.d.) LMWH (b.i.d.) s.i.d.=single in die; b.i.d.= bis in die Dose (U/kg) 60.6 (±12.8) 65.9 (±17.4) Patients-number 55 329 93 Complications TE n (%) 0 2 (0.6) 0 arterial 0 2 (0.6) 0 venous 0 0 0 Bleeding n (%) 0 9 (2.7) 7 (7.5) major 0 4 (1.2) 3 (3.2) minor 0 5 (1.5) 4 (4.3)
eComment: Are low molecular weight heparin effective in mechanical valve prosthesis anticoagulation during pregnancy?
