Hand Surgery on Anticoagulated Patients: A Prospective Study of 121 Operations

Edmunds, Ian; Avakian, Zorik

doi:10.1142/s0218810410004680

Cited by 33 publications

(32 citation statements)

References 16 publications

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“…Other reports have clearly linked the use of anticoagulants to postoperative bleeding. [6][7][8][9] In our series, we did not identify any specific risk factors, including postoperative bridging therapy that predisposed patients to a bleeding complication. Furthermore, McBane et al specifically looked at the risks associated with bridging therapy in 775 patients with venous thromboembolism and found no differences in thromboembolic or bleeding outcomes based on whether or not bridging therapy was used.…”

Section: Discussionmentioning

confidence: 81%

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Bleeding and Thromboembolic Outcomes for Patients on Oral Anticoagulation Undergoing Elective Colon and Rectal Abdominal Operations

Iqbal

Cima

Pembérton

2011

Journal of Gastrointestinal Surgery

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Section: Discussionmentioning

confidence: 81%

“…4,5 The true challenge lies in the heterogeneity of the existing literature. [5][6][7][8][9] We have reviewed our experience to better define the bleeding and thromboembolic risks in this challenging subset of patients specific to elective colon and rectal abdominal procedures.…”

Section: Introductionmentioning

confidence: 99%

Bleeding and Thromboembolic Outcomes for Patients on Oral Anticoagulation Undergoing Elective Colon and Rectal Abdominal Operations

Iqbal

Cima

Pembérton

2011

Journal of Gastrointestinal Surgery

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“…This is important because an important factor that is taken into consideration before taking a patient off of oral anticoagulation is the bleeding risk of the operation [9]. Uninterrupted anticoagulation with warfarin has been shown to be safe with a low risk of bleeding such as hand, cataract, dental, and skin surgery [19]. However, operations with an intermediate or high risk of bleeding require stopping warfarin 4-5 days before surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative INR and postoperative major bleeding and mortality: A retrospective cohort study

Tamim

Habbal

Saliba

et al. 2015

J Thromb Thrombolysis

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Little research has been done on the current cut-off international normalized ratio (INR) value of 1.5 for patients undergoing surgery. The objectives of this study are to assess the association between INR and postoperative major bleeding and mortality in patients undergoing surgery and to identify an ideal pre-operative INR for surgical patients. We analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program database between 2008 and 2011 (636,231 patients). The primary outcomes were major bleeding and mortality at 30 days postoperatively. Multivariate logistic regression analyses were carried out to assess these associations. Compared to an INR of <1, the adjusted odds ratio (aOR) for major bleeding was 1.22 (95 % CI 1.18-1.25) for INR 1-1.49, 1.48 (95 % CI 1.40-1.56) for INR 1.5-1.9, and 1.49 (95 % CI 1.39-1.60) for INR ≥2. The aOR for mortality at 30 days post-operation compared to INR of <1 was 1.51 (95 % CI 1.41-1.62), 2.31 (95 % CI 2.12-2.52), and 2.81 (95 % CI 2.56-3.10) for INR 1-1.49, 1.5-1.9, and ≥2, respectively. The ideal pre-operative INR value to predict an increased risk for major bleeding was 1.10 and 1.13 for mortality. In conclusion, preoperative INR is significantly and independently associated with postoperative major bleeding and mortality.

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“…[16] In that series, 24 patients were taking both clopidogrel and aspirin. A single major complication of hematoma requiring surgical evacuation occurred in a patient with rheumatoid arthritis following ulnar head excision with synovectomy and extensor tendon transfers.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Antiplatelet Medication on Hand and Wrist Surgery

Bogunovic

Gelberman

Goldfarb

et al. 2013

The Journal of Hand Surgery

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Purpose To quantify the impact of maintaining antiplatelet medication during hand and wrist surgery on bleeding and functional outcomes. Methods This prospective cohort trial compared operative outcomes and complications of hand and wrist surgery in patients without interruption of daily antiplatelet medications (n=107 procedures) to control patients (n=107 procedures). Rates of complications requiring reoperation were determined for each group. Measures of surgical site bleeding (extent of ecchymosis, hematoma formation), patient-rated outcome assessment (Quick Disabilities of the Arm, Shoulder, and Hand score, visual analog scales of pain and swelling), and 2-point discrimination were compared between groups. Data were collected preoperatively and postoperatively at 2 and 4 weeks. Control and antiplatelet populations were confirmed to be similar for data analysis according to health status (Short Form-12) and percentage of bony procedures. Results One patient on antiplatelet medication required reoperation for surgical site bleeding following wrist arthrodesis (0.9%). There were no complications in the control group. The extent of postoperative ecchymosis was similar in the antiplatelet and control patients at 2 weeks (16mm vs 19mm) and 4 weeks (1mm vs 1mm). Hematoma rates were not increased for patients on antiplatelet medication (17% vs 14% at 2 weeks). Patient-rated function scores were equivalent at baseline and at follow up between groups. Twenty-two control patients and 20 patients on antiplatelet medication had transiently increased 2-point discrimination (≥2mm change) postoperatively. Conclusions Bleeding-related perioperative complications were rare when continuing antiplatelet medications without interruption for hand and wrist surgery. Maintenance of antiplatelet medication does not appear to negatively impact patient-rated or objective measures of function although surgical-site bleeding may be greatest in patients taking higher dose antiplatelet medication and undergoing bony procedures. Level of Evidence II, Prospective Therapeutic

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Hand Surgery on Anticoagulated Patients: A Prospective Study of 121 Operations

Cited by 33 publications

References 16 publications

Bleeding and Thromboembolic Outcomes for Patients on Oral Anticoagulation Undergoing Elective Colon and Rectal Abdominal Operations

Bleeding and Thromboembolic Outcomes for Patients on Oral Anticoagulation Undergoing Elective Colon and Rectal Abdominal Operations

Preoperative INR and postoperative major bleeding and mortality: A retrospective cohort study

The Impact of Antiplatelet Medication on Hand and Wrist Surgery

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