Magazine article Drug Topics

Anticoagulation May Be Safe for Many Outpatient Procedures

Magazine article Drug Topics

Anticoagulation May Be Safe for Many Outpatient Procedures

Article excerpt


Many patients who need anticoagulation also need minor outpatient surgical procedures. This raises questions regarding management of anticoagulation during the perioperative time. Although pharmacists are not responsible for making decisions about interrupting anticoagulation, it is helpful to know guidelines for common procedures.

Common outpatient procedures and recommendations regarding anticoagulation include dental procedures, gastrointestinal (GI) procedures, skin biopsies, and cataract removal.

For dental procedures, if the INR is within the therapeutic range, the risk of bleeding is minimal, including in the case of surgical extractions, Mouthwashes containing tranexemic acid may help minimize bleeding. For GI procedures, including colonoscopies and endoscopy, in which biopsies are not anticipated and overall risk is low, anticoagulation can be continued. When the procedural risk is high, but the patient has a low risk for thromboembolism, anticoagulation should be withheld as it would before any other surgery. If the risk for thromboembolism is high, bridging should be offered before surgery.

For skin biopsies, anticoagulation can be continued as these are considered minor procedures in which complications can be controlled. Finally, anticoagulation can be continued when undertaking cataract removal.

For many common outpatient procedures, anticoagulation may be safely continued.

Source: Weinberg I. Anticoagulation and surgery. Vascular medicine, Accessed February 9, 2012.

Valid quality measure for joint arthroplasty?

A systematic review of studies that examined patients who underwent joint replacement surgery and were taking the recommended anticoagulant prophylaxis estimates that 1 in 100 patients who undergo knee replacement and 1 in 200 who undergo hip replacement will suffer a symptomatic venous thromboembolic (VTE) event.

The authors conducted the meta-analysis of randomized clinical trials and observational studies of postoperative VTE rates carried out in almost 45,000 patients who received prophylaxis with a low-molecular-weight heparin, subcutaneous factor Xa inhibitor, or oral direct inhibitor of factors Xa or ïa.

In an accompanying editorial, the true picture of risk is called into question. It is suggested that use of symptomatic VTE detection before discharge as a safety indicator may be suboptimal because the period of risk for this event extends weeks beyond the hospitalization, A typical hospitalization for joint replacement is now 3 to 4 days. …

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