PERIOPERATIVE BRIDGING THERAPY WITH LOW MOLECULAR WEIGH HEPARIN IN PATIENTS REQUIRING INTERRUPTION OF LONG-TERM ORAL ANTICOAGULANT THERAPY

Abstract number: P-W-670

Malato¹ A., Cigna¹ V., Saccullo¹ G., Abbene¹ I., Anastasio¹ R., Lo Coco¹ L., Siragusa¹ S.

¹Thrombosis Haemostasis and Haematology Unit, University Hospital of Palermo, Palermo, Italy

How-to-cite Malato A, Cigna V, Saccullo G, Abbene I, Anastasio R, Lo Coco L, Siragusa S. PERIOPERATIVE BRIDGING THERAPY WITH LOW MOLECULAR WEIGH HEPARIN IN PATIENTS REQUIRING INTERRUPTION OF LONG-TERM ORAL ANTICOAGULANT THERAPY. J Thromb Haemost 2007; 5 Supplement 2: P-W-670

Abstract

Introduction: The efficacy and safety of withholding oral anticoagulants (OACs) in patients candidated to invasive procedures has not been well established. We conducted a cohort study in 228 anticoagulated patients requiring anticogulants interrumption because of planned surgery at risk of bleeding.

Methods: Accordingly to the index thrombotic event requiring long-term anticoagulation, patients were considered at low- or high-risk. In all of them, OACs were discontinued 5 days prior to the invasive procedure. In low-risk patients for thrombosis (venous thrombosis lasted more than 3 months, atrial fibrillation without stroke, prosthetic aortic valves), prophylactic Low Molecular Weight Heparins (LMWHs) were commenced the night before the procedure. In those at high-risk for thrombosis (atrial fibrillation with previous thromboembolism, prosthetic mitralic valves, recent venous thrombosis), therapeutic LMWHs were started 3-4 days prior surgery. In the post-operative period, anticoagulation (at prophylactic or theraputic doses) was restarted the evening or 12-24 hours after procedure. The incidence of primary outcomes (thrombotic and haemorragic events) were evaluated until 28 days post-procedure.

Results: All patients received LMWHs (intention-to-treat group); 43 (18.8%) underwent major surgery, 58 (25.4%) minor surgery and 127 (55.7%) other invasive procedures. Total events occurred during the 28 days follow-up are reported in Table. Three of 5 major haemorragic events occurred in orthopaedic surgery; none was intracranial, retroperitoneal, intraocular, or fatal.

Table:

	Low-risk 132 (60)	High-risk, 96 (40)
Thrombosis, n (%)	1 (0.75)	3 (3.1)
Arterial	0	3 (3.1)
Venous	1 (0.75)	0
Bleeding, n (%)	5 (3.8)	12 (12.5)
Major	1 (0.75)	5 (5.2)
Minor	4 (3)	7 (7.3)

Conclusions: Our approach permits to safely and efficaciously manage patients undergoing surgery or invasive procedures that required interruption of OACs.

To cite this abstract use the following format:

Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number

Session Details

Date:	01/08/2007
Time:	00:00-00:00
Session name:	XXIst ISTH Congress
Subject:
Location:	Oxford, UK
Presentation type:
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