Of those respondents who preferred IV heparin for postoperative anticoagulation therapy, the risk of bleeding influenced the timing of heparin initiation.
A significantly higher proportion of respondents […]
Our finding that the risk of TE, but not the risk of bleeding, influenced the aggressiveness of anticoagulant management may be explained by the following considerations. First, physicians may consider the prevention of TE as the primary management objective because the clinical consequence of TE (eg, stroke), resulting from less aggressive anticoagulation therapy, is likely to be greater than that of bleeding (eg, wound hematoma), resulting from aggressive anticoagulation therapy. […]
Furthermore, most patients in these studies had first-generation caged-ball heart valves, which are more thrombogenic than newer bileaflet tilting-disk models. In two methodologically rigorous studies that provided quantitative estimates […]
The effect of bleeding risk on postoperative anticoagulation preferences is summarized in Table 3. The risk of bleeding did not have a detectable effect on postoperative anticoagulation preferences, inasmuch as the proportion of respondents who preferred aggressive anticoagulant management was not significantly different in high-risk and low-risk bleeding scenarios.
The effect of TE or bleeding risk on the timing of postoperative IV heparin initiation is summarized in Table 4. […]
Survey Response Rate and Characteristics of Respondents
The survey was mailed to 960 physicians; 87 surveys were returned because the physician no longer resided at the address that […]
The survey was mailed to all members of the Canadian Society of Internal Medicine (n = 420) and the Canadian Cardiovascular Society (n = 540) in July 1997, with a repeat mailing in December 1997 to nonresponders. A priori, criteria were established to exclude returned surveys from the analysis: (1) physician does not manage anticoagulant-related problems in adults; (2) physician no longer resides at the address provided, […]
In patients with a mechanical heart valve who are receiving long-term oral anticoagulant therapy and are undergoing elective surgery, the management of perioperative anticoagulation therapy is problematic. Temporary discontinuation of anticoagulants increases the risk […]
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