Perioperative Anticoagulation in Patients With a Mechanical Heart Valve Who Are Undergoing Elective Noncardiac Surgery: Conclusion

In: Mechanical Heart

24 Sep 2014

Perioperative Anticoagulation in Patients With a Mechanical Heart Valve Who Are Undergoing Elective Noncardiac Surgery: ConclusionOf 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 safe to initiate IV heparin after surgery. Presumably, this will depend on the surgical procedure, inasmuch as patients undergoing urologic, neurosurgical, or cancer-related procedures are more susceptible to postoperative bleeding.- It is possible that withholding IV heparin for as little as 24 to 48 h after surgery might substantially reduce the risk of postoperative bleeding, although having a negligible effect on patients’ risk of TE. add comment

The are several points that support the validity and generalizability of our findings. First, the anticoagulation options we provided were chosen by > 98% of respondents, depending on the scenario, thereby suggesting that the responses in this survey are a valid representation of physicians’ usual clinical practice. Second, the respondents were from a broad cross-section of specialties that included general internal medicine, cardiology, and cardiac surgery. Third, because 86% of respondents managed anticoagulant-related problems frequently, our findings are generalizable to other physicians who manage anticoagulant-related problems. We acknowledge that the survey response rate of 62% might be considered suboptimal; however, this response rate is consistent with rates reported in other surveys of anticoagulant-related practices.
To summarize, there is a need for large, prospective studies to investigate the efficacy and safety of the anticoagulation preferences identified in this survey, and to provide reliable estimates of the risks of perioperative TE and bleeding associated with different anticoagulation strategies.

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