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 preferred later heparin initiation (ie, > 12 h after surgery) in high-risk bleeding scenarios compared with low-risk bleeding scenarios. To our knowledge, there are no studies investigating when it is […]
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 […]
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 of the risks of TE and bleeding for patients with a mechanical heart valve who require elective surgery, the investigators questioned the use of perioperative IV […]
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 […]
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 was provided. Of 873 physicians who received the survey, 538 (62%) responded. Of 538 returned surveys, 65 were excluded for the following reasons: (1) physician does not […]
Survey Methods 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 […]
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 of valve thrombosis and systemic embolism. On the other hand, continuing anticoagulants perioperatively, or stopping and restarting anticoagulants too soon after […]
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