Perioperative Anticoagulation in Patients with Mechanical Heart Valves Undergoing Elective Surgery: Results of a Survey Conducted among Korean Physicians
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Abstract
The optimal perioperative anticoagulation management in patients on warfarin therapy is poorly defined due to the lack of randomized trials. Because guidelines are heterogeneous, it was hypothesized that “treatment strategies are not uniform in clinical practice”. Between February 2003 and May 2003, a questionnaire with 4 different clinical scenarios was distributed to physicians by e-mail, or direct contact was made by a survey monitor. Two scenarios described the cases of patients with a mechanical heart valve (MHV) in the mitral position, with additional risk factors for a systemic embolism; one undergoing major (scenario 1) and the other minor surgery (scenario 3). Two scenarios described patients with an aortic MHV; one undergoing major (scenario 2) and the other minor (scenario 4) surgery. Different preoperative and postoperative management options were offered. The treatment options for all scenarios were the same. Of the 90 questionnaires distributed, 52 (57.8%) were returned. Hospitalization for full-dose intravenous unfractionated heparin (IV UH) was the most commonly selected strategy in the preoperative phase for scenarios 1 (59%), 2 (42%) and 3 (44%). In scenario 4, 34% chose IV UH. Outpatient, full- dose, subcutaneous UH or low-molecular-weight heparin (LMWH) was the most selected option in the postoperative phase for all scenarios, with the exception of number 4 (52.9% in scenario 1, 34% in scenario 2, 32%, in scenario 3 and 28% in scenario 4). Even among expert clinicians, the management of perioperative anticoagulation is heterogeneous. In particular, the definition of risk categories and the optimal intensity of antithrombotic drugs need to be defined by well-designed prospective studies.
참고문헌 (24)
- "Perioperative management of long-term anticoagulation", 24(1), pp.77~83 (1998)
- "Guidelines for the management of patients with valvular heart disease A report of the American College of Cardiology", American Heart Association Task force on Practice Guidelines Committee on Management of Patients with Valvular Heart Disease, 1998, pp.98, 1949~84
- "Managing oral anticoagulant therapy", 119, pp.225~386 (2001)
- "Perioperative anticoagulation management in patients who are receiving oral anticoagulant therapy a practical guide for clinicians", 108, pp.3~13 (2003)
- "The management of patients on long term oral anticoagulant therapy undergoing surgery", 87(2), pp.48~50 (2002)
- "A guide to oral anticoagulant treatment Recommendations of the Italian Federation of Anticoagulation Clinics", 88(2), pp.39~41 (2003)
- "Management of anticoagulation before and after elective surgery", 336, pp.1506~11 (1997)
- "Antithrombotic therapy after heart valve replacement. In: Yusuf S, Cairns JA, Camm AJ, Fallen EL, Gersh BJ ed.", (w), pp.832~6 (2003), BMJ Books
- "Physician preferences for perioperative anticoagulation in patients with a mechanical heart valve who are undergoing elective noncardiac surgery", 116, pp.1240~46 (1999)
- "multicenter randomised comparison of low-dose versus standard-dose anticoagulation in patients with mechanical prosthetic heart valves", 94, pp.2107~12 (1996)
- "Lower intensity anticoagulation therapy results in lower complication rates with the St", pp.1136~45
- "Long term results with the Medtronic-Hall valvular prosthesis", 61, pp.806~13 (1996)
- "Antithrombotic therapy in patients with mechanical or biological prosthetic heart valves", 119, pp.220~7 (2001)
- "A meta-analysis comparing low-molecular- weight heparins with unfractionated heparin in the treatment of venous thromboembolism examining some unanswered questions regarding location of treatment", 180, pp.181~8 (2000)
- "Clinical outcomes with the use of unfractionated heparin or low-molecular- weight heparin as perioperative bridging therapy in patients on long-term oral anticoagulants: Rationale, objectives, and design of a large, long-term study (REGIMEN)." (2003)
- , 2003, ~
- , 2001, ~
- , 2001, ~
- "Outpatient peri-operative and peri-procedure treatment with dalteparin for chronically anticoagulated patients at high risk for thromboembolic complications", (662.) (1999)
- "Use of enoxaparin for the chronically anticoagulated patient before and after procedures", 84, pp.478~80 (1999)
- "Prospective study of the use of low molecular weight heparin vs unfractionated heparin as bridging therapy for invasive procedures in patients anticoagulated with acenocoumarol", (3648) (2001)
- , 2001, ~
- "Experience with enoxaparin in patients with mechanical heart valves who must withhold acenocoumarol", 89, pp.527~30 (2003)
- "Prospective multicenter trial of bridging therapy with dalteparin for patients who require temporary discontinuation of OAT with prosthetic heart valves or high risk atrial fibrillation", 100(149), pp.100~ (2002)