The perioperative use of oral anticoagulants during surgical procedures for carpal tunnel syndrome. A preliminary study

Tewarie, Rishi Nandoe; Bartels, Ronald H. M. A.

doi:10.1007/s00701-010-0603-z

Cited by 9 publications

(12 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are low-quality to moderate-quality data showing that therapy with VKAs, including warfarin, acenocoumarol, and phenprocoumon, does not require interruption for minor procedures, as shown in Table 2. These include dental procedures (tooth extraction; root canal), skin procedures (biopsy; skin cancer removal), and cataract surgery [20][21][22][23][24][25][26][27]. The 2012 ACCP Antithrombotic Therapy Guidelines give only weak Grade 2C recommendations for continuing VKA therapy in these specific situations involving minor procedures, as they have been associated with a low risk of bleeding [3].…”

Section: Overall Periprocedural Antithrombotic Strategymentioning

confidence: 99%

Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery

Spyropoulos

AlBadri²,

Sherwood

et al. 2016

Journal of Thrombosis and Haemostasis

153

144

View full text Add to dashboard Cite

To cite this article: Spyropoulos AC, Al-Badri A, Sherwood MW, Douketis JD. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost 2016; 14: 875-85.Summary. The periprocedural management of patients receiving chronic therapy with oral anticoagulants (OACs), including vitamin K antagonists (VKAs) such as warfarin and direct OACs (DOACs), is a common clinical problem. The optimal perioperative management of patients receiving chronic OAC therapy is anchored on four key principles: (i) risk stratification of patient-related and procedure-related risks of thrombosis and bleeding; (ii) the clinical consequences of a thrombotic or bleeding event; (iii) discontinuation and reinitiation of OAC therapy on the basis of the pharmacokinetic properties of each agent; and (iv) whether aggressive management such as the use of periprocedural heparin bridging has advantages for the prevention of postoperative thromboembolism at the cost of a possible increase in bleeding risk. Recent data from randomized trials in patients receiving VKAs undergoing pacemaker/defibrillator implantation or using heparin bridging therapy for elective procedures or surgeries can now inform best practice. There are also emerging data on periprocedural outcomes in the DOAC trials for patients with non-valvular atrial fibrillation. This review summarizes the evidence for the periprocedural management of patients receiving chronic OAC therapy, focusing on recent randomized trials and large outcome studies, to address three key clinical scenarios: (i) can OAC therapy be safely continued for minor procedures or surgeries; (ii) if therapy with VKAs (especially warfarin) needs to be temporarily interrupted for an elective procedure/surgery, is heparin bridging necessary; and (iii) what is the optimal periprocedural management of the DOACs? In answering these questions, we aim to provide updated clinical guidance for the periprocedural management of patients receiving VKA or DOAC therapy, including the use of heparin bridging.

show abstract

Section: Overall Periprocedural Antithrombotic Strategymentioning

confidence: 99%

Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery

Spyropoulos

AlBadri²,

Sherwood

et al. 2016

Journal of Thrombosis and Haemostasis

153

144

View full text Add to dashboard Cite

show abstract

“…Firstly, the studies only included surgery distal to the wrist and the vast majority were carpal tunnel releases so it remains to be seen whether these findings can be extrapolated to other procedures. Secondly, the type of anesthesia was not specified in all studies 24,25,31,32 and it is unclear if there is an advantage using general anesthesia, a neuraxial block 27,30 or local anesthesia 28,30 exclusively or with epinephrine 26,29 with regards to postoperative bleeding complications. Thirdly, wide awake local anesthesia no tourniquet (WALANT) in minor hand surgery procedures has been shown to decrease tourniquet-associated discomfort and improve the perioperative patient experience 34 , but only one study did not use a tourniquet 26 .…”

Section: Question: 4 - Should Anticoagulants Be Held Prior To Perform...mentioning

confidence: 99%

“…Nine studies [24][25][26][27][28][29][30][31][32] and one meta-analysis 33 examined the effect of antiplatelet and anticoagulant medications on complication rate in hand or wrist surgery. Of these nine studies, four 26,28,29,32 were retrospective and five 24,25,27,30,31 were prospective cohort studies.…”

Section: Jacobmentioning

confidence: 99%

“…Of these nine studies, four 26,28,29,32 were retrospective and five 24,25,27,30,31 were prospective cohort studies. In five studies 24,[26][27][28][29] the effect of antiplatelets was investigated, while four studies 25,[30][31][32] looked at anticoagulants or an elevated international normalized ration( INR). Surgery was performed without a tourniquet in one study 26 , with tourniquet deflation and hemostasis before skin closure in one study 28 , and according to the surgeon's preference in two studies 24,25 .…”

Section: Jacobmentioning

confidence: 99%

See 1 more Smart Citation

Recommendations from the ICM-VTE: Hand & Wrist

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The ICM-VTE Hand & Wrist Delegates* Question: 1 -Concerning VTE risk, which surgeries can be considered major, and which surgeries can be considered non-major in hand surgery?Response/Recommendation: Surgeries involving general anesthesia for >90 minutes, surgeries requiring bedrest or limited ambulation postoperatively, and surgeries involving replantation or free vascularized tissue transfer should be considered major in Hand Surgery.Strength of Recommendation: Consensus.Delegates vote: Agree 90.48% Disagree 4.76% Abstain 4.76% (Strong Consensus)Rationale: Risk factors for venous thromboembolism (VTE) following hand surgery are poorly studied. This is partly due to the very low incidence of these adverse events, which was determined to be 0.0018% by Hastie et al., in a sample of 3,357 consecutive upper extremity surgeries 1 . As a result, it is extremely challenging to stratify procedures into high-or low-risk categories for VTE.Some studies of VTE risk following surgical procedures have included hand and wrist surgery in their samples. A study by Keller et al., of VTE following endoprosthesis surgeries included 183,420 upper extremity surgeries and reported a 0.4% incidence of VTE (2.69 times lower than that of lower extremity endoprosthesis surgery), but this study did not differentiate between hand, wrist, elbow, and shoulder procedures 2 . Similarly, studies investigating VTE prophylaxis following free tissue transfer have included upper extremity tissue transfers. Ricci et al., recommended subcutaneous heparin VTE prophylaxis following upper extremity free flaps, but based this recommendation on expert opinion given the lack of available evidence 3 . A National Surgical Quality Improvement Program (NSQIP) database study of VTE following plastic surgery analyzed 19,276 plastic surgery cases performed under general anesthesia and found a VTE incidence of 1.3% in cases lasting over 5 hours. In cases lasting less than 5 hours, VTE incidence was less than 0.36%. There were no hand surgical procedures that resulted in >2 VTE within this sample, although the total number of hand surgical cases that were complicated by VTE was not reported 4 . Consensus guidelines from the British Society for Surgery of the Hand (BSSH) cur-rently recommend mechanical VTE prophylaxis for cases under general anesthesia lasting >90 minutes and/or in patients with at least one VTE risk factor, and recommend the consideration of pharmacological prophylaxis in patients undergoing >90 minutes of general anesthesia with more than one risk factor, or prolonged immobility 5 .Given the lack of evidence differentiating high-and lowrisk hand surgeries, further study in this topic is needed, and current recommendations are based on a consensus of opinion among experts.

show abstract

“…More recently, two prospective studies concurred that the continuation of anticoagulation for hand surgery is safe. [4,5] As described by Nandoe Tewarie and Bartels, of the 52 patients (out of 364) on anticoagulants, only one patient, who was on aspirin developed postoperative subcutaneous bleeding. [4] Similarly, in the second study, of the 107 patients who were on anticoagulants, only one patient on clopidogrel developed a haematoma [5] .…”

mentioning

confidence: 97%