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

In: Mechanical Heart

20 Sep 2014

Perioperative Anticoagulation in Patients With a Mechanical Heart Valve Who Are Undergoing Elective Noncardiac Surgery: ResultsSurvey 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 manage anticoagulant-related problems in adults (n = 38), (2) physician has retired from medical practice (n = 17), and (3) survey was partially completed (n = 10). Thus, there were 473 surveys included in the analysis. Of the 473 respondents, 217 (46%) were cardiologists, 179 (38%) were general internists, 55 (12%) were cardiac surgeons, and 22 (4.6%) were from another specialty; 406 (86%) managed anticoagulant-related problems frequently and 67 (14%) managed them infrequently.
Responses to Clinical Scenarios
The anticoagulation preferences for the four scenarios are summarized in Figures 1 and 2. IV heparin was the most frequently selected anticoagulation option for preoperative and postoperative anticoagulation therapy in each of the four scenarios. Of those respondents who selected IV heparin for postoperative anticoagulation therapy, preferences for the timing of heparin initiation are summarized in Figure 3. Initiation of IV heparin 6 to 12 h after surgery was the most frequently selected timing for heparin initiation in each of the four scenarios, whereas heparin initiation < 6 h after surgery was least preferred by the respondents. antibiotics online

The effect of TE risk on preoperative and postoperative anticoagulation preferences is summarized in Table 3. The risk of TE had a strong influence on anticoagulation preferences. There was a significantly greater proportion of respondents who preferred aggressive preoperative and postoperative anticoagulant management in high-risk TE scenarios compared with low-risk TE scenarios.

Figure 1. Preoperative anticoagulation management preferences. For description of different scenarios and management options, see Tables 1 and 2.

Figure 1. Preoperative anticoagulation management preferences. For description of different scenarios and management options, see Tables 1 and 2.

Figure 2. Postoperative anticoagulation management preferences. For description of different scenarios and management options, see Tables 1 and 2.

Figure 2. Postoperative anticoagulation management preferences. For description of different scenarios and management options, see Tables 1 and 2.

Figure 3. Postoperative IV heparin initiation preferences. For description of different scenarios, see Table 1.

Figure 3. Postoperative IV heparin initiation preferences. For description of different scenarios, see Table 1.

Table 3—Effect of TE or Bleeding Risk on Preoperative and Postoperative Anticoagulation Preferences

AnticoagulationPreferences TE Riskf p Value
High Low
Preoperative management
Scenario 1 434 (92) < 0.001
Scenario 2 312 (66)
Scenario 3 416 (88) < 0.001
Scenario 4 288(61)
Postoperative management Bleeding risk High
Scenario 1 424 (90) < 0.001
Scenario 2 340(72)
Low
Scenario 3 415 (88) < 0.001
Scenario 4 320 (68)
p Value 0.36 0.06

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