Risk of Thromboembolism and Bleeding After General Surgery in Patients With Atrial Fibrillation

Vink, Roel; Rienstra, Michiel; Dongen, C.J.J. van; Levi, Marcel; Büller, Harry R.; Crijns, Harry J.; Gelder, Isabelle C. Van

doi:10.1016/j.amjcard.2005.05.028

Cited by 15 publications

(12 citation statements)

References 7 publications

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“…One‐fifth of patients ( n = 37) had prosthetic heart valves (30% in the mitral position) and 22% had a prior history of TE. Overall, 44% of the participants were classified as moderate to high‐risk for peri‐operative TE and the procedures undertaken showed an equal distribution of low‐moderate and moderate‐high risk for procedural bleeding, 45% and 55% respectively (Table I) (Kearon & Hirsh, 1997; Petty et al , 2000; Jaffer et al , 2003; Spyropoulos & Turpie, 2005; Vink et al , 2005; Garcia et al , 2008).…”

Section: Resultsmentioning

confidence: 99%

“… †Procedural bleeding risk based on population‐based data (Eisen et al , 2002; Spyropoulos, 2005; Vink et al , 2005; Douketis, 2008). …”

Section: Resultsmentioning

confidence: 99%

“…The risk of TE during the anticoagulation hiatus is largely unknown, empirically extrapolated from the rate and risk of recurrent TE according to the indication for anticoagulation (Jaffer et al , 2003; Garcia et al , 2008). Bleeding risk equally lacks a prediction guide, and is extrapolated from non‐anticoagulated populations undergoing similar procedures with rates around 2–4% for major bleeding (Vink et al , 2005; Douketis et al , 2008; Pisters et al , 2010). Although approximately 3% of major postoperative bleeding can be fatal, the majority of patients make a full recovery.…”

mentioning

confidence: 99%

“…Although approximately 3% of major postoperative bleeding can be fatal, the majority of patients make a full recovery. In contrast, TE complications can result in a major morbidity or death in 70% of patients (Petty et al , 2000; Vink et al , 2005). Moreover, the TE and the bleeding risks are heterogeneous and vary according to the indication for anticoagulation, type of surgery and concomitant patient risk factors.…”

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confidence: 99%

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Short‐term warfarin reversal for elective surgery – using low‐dose intravenous vitamin K: safe, reliable and convenient*

Burbury¹,

Milner

Snooks

et al. 2011

Br J Haematol

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Summary Peri‐procedural management of warfarin reflects an intricate balance between the restoration of haemostasis and appropriate thromboprophylaxis. This prospective single‐arm study assessed the safety and efficacy of a convenient schedule, incorporating low‐dose intravenous vitamin K (vitKIV) for short‐term warfarin reversal prior to elective surgery, as well as vitK‐dependent factor levels (vitK‐Factors) and International Normalized Ratio (INR) pre‐ and post‐vitKIV. One seventy eight patients on long‐term warfarin received 3 mg vitKIV 12–18 h pre‐procedure with no adverse reactions. 167/178 (94%) achieved an INR ≤ 1·5 post‐vitKIV on the day of surgery, while all achieved INR ≤ 1·7. Four patients had procedure‐associated major bleeding, but importantly had achieved a pre‐procedure INR < 1·5 and vitK‐Factors >0·30 iu/ml. No patient suffered a symptomatic thromboembolism during the 6‐week follow‐up. Median days to re‐establish a therapeutic INR were 4 (range 2–11). VitKIV near normalized all vitK‐Factors, with a uniform pattern of depletion and repletion in association with an increase and decrease in INR, respectively; and from the data, INR < 1·5 correlated with vitK‐Factors >0·30 iu/ml. Low‐dose vitKIV for short‐term warfarin reversal was reliable and safe, and successfully lowered the INR to an acceptable level for planned surgery, with no excess of bleeding, thromboembolism, delayed discharge, or resistance to warfarin. The protocol was simple and convenient for both the patients and the healthcare institution.

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Section: Resultsmentioning

confidence: 99%

“… †Procedural bleeding risk based on population‐based data (Eisen et al , 2002; Spyropoulos, 2005; Vink et al , 2005; Douketis, 2008). …”

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Short‐term warfarin reversal for elective surgery – using low‐dose intravenous vitamin K: safe, reliable and convenient*

Burbury¹,

Milner

Snooks

et al. 2011

Br J Haematol

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show abstract

“…10 In contrast, AF-related stroke results in a major neurologic deficit or death in 70% of patients. 3,5,10,11 Consequently, several authorities and consensus groups advocate some form of bridging therapy with a short-acting anticoagulant for most patients with AF. 7,12,13 Even in the absence of anticoagulation, invasive procedures can carry a risk of bleeding for up to 1 week.…”

mentioning

confidence: 99%