Elective Hand Surgery in Patients Taking Warfarin

Smit, A. J.; Hooper, G.

doi:10.1016/j.jhsb.2003.12.012

Cited by 27 publications

(28 citation statements)

References 5 publications

(6 reference statements)

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“…What has become apparent, however, is that the risk of bleeding is dependent on the nature of the procedure being performed [23]. Whilst warfarin need not be discontinued for elective hand surgery, most authors conclude that major surgery can only be performed if the INR is < 1.5 [24][25][26]. About 35% of the respondents in our study would, however, consider hemiarthroplasty with an INR > 1.5 and < 2.0.…”

Section: Discussionmentioning

confidence: 70%

Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice

Starks

Cooke

Docker

et al. 2008

Eur J Trauma Emerg Surg

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Hip fracture in the presence of long-term warfarin use is associated with significantly increased morbidity. This problem is likely to increase. Our results demonstrate variation in approach throughout the UK with regard to warfarin reversal and the acceptable INR at which to operate in this group of patients. We propose that low-dose vitamin K is considered more widely as a safe and effective method of warfarin reversal in this group.

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Section: Discussionmentioning

confidence: 70%

Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice

Starks

Cooke

Docker

et al. 2008

Eur J Trauma Emerg Surg

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“…Smit et al reported no complications following open carpal tunnel release (n=9) and fasciotomy for Dupuytren contractures (n=13) in patients taking warfarin. 18 A second series reported 2 hematomas that resolved with nonoperative treatment after 55 procedures (soft tissue and bony) in 39 patients on warfarin. 17 In one prospective cohort, 57 operations (49 soft tissue, 8 bony) were completed without interruption of warfarin (INR<3.0).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Uninterrupted Warfarin on Hand and Wrist Surgery

Bogunovic¹,

Gelberman²,

Goldfarb³

et al. 2015

The Journal of Hand Surgery

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Purpose To determine the impact of uninterrupted use of warfarin on hand and wrist surgery. Methods This single-center, prospective cohort trial enrolled adult patients undergoing hand and wrist surgery. Between May 2009 and August 2014, 47 surgical patients on uninterrupted warfarin (50 procedures) were enrolled and matched as a group by age and procedure type to 48 surgical patients (50 procedures) who were not prescribed warfarin. Complications, defined as bleeding, infection, or wound dehiscence requiring reoperation, were recorded for each group. Surgical outcome measures comprised objective findings impacted by surgical site bleeding (i.e., ecchymosis extent, hematoma presence, 2-point discrimination) and standardized patient-rated assessments (QuickDASH, visual analog scales: pain and swelling). Data were collected preoperatively and at 2 and 4 weeks postoperatively. Statistical analyses contrasted complications and outcomes data between the patient groups. Results One procedure (2%, 95% CI:0–11%) in a patient taking warfarin was complicated by hematoma requiring reoperation secondary to an elevated postoperative International Normalized Ratio=5.4. There were no complications among controls (0%, 95%CI:0–7%). At 2 weeks postoperatively, patients on warfarin more frequently had hematomas (28% vs 10%) and demonstrated greater extent of ecchymosis from the surgical incision (50mm vs 19mm). At 4 weeks, no differences in hematoma presence or extent of ecchymosis existed between the groups. The incidence of transiently elevated 2-point discrimination was not different between the groups (10% warfarin, 6% controls). Visual analog scores for pain and swelling were not significantly different between the groups at any time. Differences in QuickDASH scores between the groups never exceeded a minimal clinically important difference. Conclusions Uninterrupted use of warfarin in patients undergoing surgery of the hand and wrist was associated with an infrequent risk of bleeding complication requiring reoperation. Increased rates of hematoma and ecchymosis in patients taking warfarin normalized by 4 weeks postoperatively. Level of Evidence II Therapeutic

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“…11,13,15 Data to support either approach are limited and relate mainly to the literature on cardiothoracic procedures (in favor of discontinuing treatment), 14 or orthopedic and ocular surgery (favoring continued treatment). [30][31][32] A 2007 audit on the United Kingdom community of vascular surgeons investigated clopidogrel use at the time of CEA and established that 52% of surgeons discontinue it preoperatively, and 51% of them administer no alternative, whereas 49% replace it with ASA. 13 No data were available on how many days before CEA the treatment was stopped.…”

Section: Discussionmentioning

confidence: 99%

Predictors of neck bleeding after eversion carotid endarterectomy

Baracchini

Gruppo

Mazzalai

et al. 2011

Journal of Vascular Surgery

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The results of this single-center university hospital study show that neck bleeding after CEA is relatively common but is not associated with an increased risk of stroke or death. Preoperative treatment with clopidogrel, particularly when it is continued to the day before surgery, and postoperative arterial hypertension seem to be associated with a higher risk of neck bleeding after CEA, requiring re-exploration in most cases. Other antiplatelet agents appear to be associated with an increased risk of postoperative neck bleeding only if they are continued to the day before CEA. Larger studies are warranted to confirm our findings and prevent this feared surgical complication.

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Elective Hand Surgery in Patients Taking Warfarin

Cited by 27 publications

References 5 publications

Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice

Warfarinized Patients with Proximal Femoral Fractures: Survey of UK Clinical Practice

The Impact of Uninterrupted Warfarin on Hand and Wrist Surgery

Predictors of neck bleeding after eversion carotid endarterectomy

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