Guideline-Discordant Periprocedural Interruptions in Warfarin Therapy

Abstract

Background-Periprocedural interruptions in warfarin therapy increase thromboembolic risks to patients and are not indicated for all procedures. We sought to determine the frequency and guideline concordance of periprocedural warfarin interruptions to inform a future educational intervention. Methods and Results-In October and November of 2009, an anonymous postal survey was sent to all patients followed for more than 1 year by the University of Michigan Anticoagulation service. Patients were asked how many times in the prior year they were requested to interrupt warfarin therapy for a medical or dental procedure or test and the specific indication for the requested interruption in warfarin therapy. A total of 1686 of 2133 (79%) subjects responded. The mean age of respondents was 69 years (SDϭ14 years). The majority were men (56%) and white (93%). Atrial fibrillation was the most common indication for warfarin therapy (nϭ966, 57%). At least 1 request to interrupt warfarin therapy in the prior year was given by 819 of 1648 (50%) respondents, including 481 of the 947 (51%) respondents taking warfarin for atrial fibrillation. Forty-eight percent of requests to interrupt warfarin among all respondents and 50% of requests to interrupt warfarin among those taking warfarin, specifically for atrial fibrillation, were for indications not supported by guideline statements. Conclusions-Periprocedural

The use of a biologic topical haemostatic agent (TachoSil ® ) for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroid surgery: A randomised controlled pilot trial

“…It has been reported that 50% of people on VKA therapy undergo invasive procedures at least once during the first year of treatment [1] and up to 11% of those taking antiplatelet agents for coronary stents require surgery within 2 years of stenting [2].…”

“…frequently encountered in general surgery [1,2]. Given the high risk of intra-and postoperative bleeding, the management of these patients may involve the temporary interruption of such medications and, especially in the case of vitamin K antagonists (VKAs), perioperative replacing with short-acting anticoagulants, such as ultrafractioned heparin (UFH) or low-molecular-weight heparin (LMWH).…”

Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan

“…This study also demonstrated the feasibility of dental treatment performed for stroke inpatients undergoing rehabilitation. It was suspected that many subjects were in need of special care during dental treatment because of underlying diseases and prescribed medications. This means that dentists treating stroke patients must be aware of the therapeutic regimes relevant to stroke and other possible complications, including hemodynamics.…”

The periprocedural management of novel oral anticoagulants in patients with nonvalvular atrial fibrillation: Rationale and a summary of the available evidence from phase 3 clinical trials

“…Each year, approximately 20% to 50% of patients with AF are directed to temporarily interrupt anticoagulant therapy for an elective procedure. 8,9 In the RE-LY trial, 25% of patients in each treatment arm had an interruption of therapy at least once for an invasive procedure. 10 Data from ROCKET-AF and ARISTOTLE show rates of temporary interruption of approximately 33% in each trial, again emphasizing how common this clinical scenario is likely to be in day-to-day practice.…”