Anticoagulation Management in the Ambulatory Surgical Setting

Abstract

Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.

Anticoagulantes na prática cirúrgica dermatológica

“…8 Prática comum era a utilização de terapias-ponte com heparina em momentos de suspensão da warfarina, com extensa demonstração de aumento dos eventos hemorrágicos, 6,8,20,21 sendo atualmente desaconselhada no âmbito da cirurgia dermatológica. 22 Considera-se atualmente que o INR < do que 3 não contraindica a cirurgia dermatológica, mesmo aquelas com reconstruções mais complexas como retalhos ou enxertos. 8,18,25 Se o INR apresentar-se > do que 3 sugere-se postergar a cirurgia até que o INR possa estar na margem de segurança.…”

Don't stop antithrombotics for cutaneous surgery: just do it now!

“…The international normalized ratio must be checked on the eve of a procedure, and it must be < 3 for a care procedure to go ahead. The authors discuss bridging with low‐molecular‐weight heparin, but in daily practice in the very great majority of cases this issue no longer arises for our kind of surgery …”