Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome

Bombuy, Ernest; Mans, Esther; Hugué, Alejandro; Plensa, Esther; Rodríguez, L. García; Prats, Miquel Àngel; Suñol, Xavier

doi:10.1016/s2173-5077(09)70070-5

Cited by 9 publications

(5 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The incidence of bleeding complications found in this study was similar to the rates reported by Bombuy et al 9 , who employed the same standard LMWH bridging protocol for patients on long-term warfarin therapy undergoing elective hernia repair. In their study, among 47 patients bridged with LMWH in the perioperative period, 6 (13%) had surgical-site hematoma and 1 patient had major bleeding, necessitating surgical intervention 9 . No thromboembolic events or deaths were seen in either study.…”

Section: Discussionsupporting

confidence: 89%

Factors associated with bleeding complications in hernia repair of warfarin users

Dumlu

Kılınç

Parlak

et al. 2021

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

OBJECTIVE: In this retrospective study, we aimed to determine factors associated with bleeding complications in patients on long-term warfarin, undergoing inguinal hernia repair using low-molecular-weight heparin (LMWH) bridging. METHODS: Two-year hospital records yielded 44 inguinal hernia repair patients on long-term warfarin (26 men, 4 women, aged 57.4 [38-72] years). All patients were managed with LMWH bridging. Patient and operative characteristics, LMWH bridging characteristics, and international normalized ratio (INR) values were compared between patients with and without postoperative bleeding complications. RESULTS: Indication for warfarin use was heart valve disease (n=15), atrial fibrillation (n=7), deep venous thrombosis (n=3), cerebrovascular event (n=3), and pulmonary embolism (n=2). Four of the operations were urgent, while the remaining were elective. There were four ecchymosis cases and three hematoma cases in a total of seven patients. Baseline (2.94±0.26 versus 2.16±0.38, p<0.001) and preoperative INR values (1.69±0.67 versus 1.31±0.35, p=0.027) were significantly higher, while postoperative INR values (1.04±0.09 versus 1.2±0.13, p=0.004) were significantly lower in patients having bleeding complications. CONCLUSIONS: Baseline, preoperative INR, and postoperative INR were the only variables associated with postoperative bleeding complications in patients undergoing LMWH-bridged inguinal hernia repair. We suggest close monitoring of INR levels in long-term warfarin users, even for relatively low-bleeding risk operations such as inguinal hernia repair.

show abstract

Section: Discussionsupporting

confidence: 89%

Factors associated with bleeding complications in hernia repair of warfarin users

Dumlu

Kılınç

Parlak

et al. 2021

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

show abstract

“…It is well known that periprocedural interruption of OAC may increase the risk of thromboembolic events, whereas continuation of OAC may expose the patients to the risk of bleeding . Guidelines from the American College of Chest Physicians recommended that bridging anticoagulation could be used with a therapeutic dose of LWMH or UFH during interruption of OAC in patients with a mechanical heart valve, atrial fibrillation, or venous thromboembolism .…”

Section: Bleeding Eventsmentioning

confidence: 99%

“…However, if these patients have an indication for implantation of cardiac implantable electronic devices (CIEDs) such as pacemaker, implantable cardioverter‐defibrillator (ICD), or cardiac resynchronization therapy (CRT), the perioperative management of anticoagulant therapy may become a puzzled problem, which requires balancing the risk of thrombosis against bleeding . Sustained anticoagulant therapy increases the risk of bleeding complications for most operative procedures, whereas periprocedural interruption of OAC increases the risk of thromboembolic complications …”

Section: Introductionmentioning

confidence: 99%

Perioperative Anticoagulation Management in Patients on Chronic Oral Anticoagulant Therapy Undergoing Cardiac Devices Implantation: A Meta‐Analysis

Zhang

Wang

et al. 2014

Pacing Clinical Electrophis

View full text Add to dashboard Cite

The perioperative anticoagulation strategy during cardiac implantable electronic devices (CIEDs) implantation is highly variable without consensus among implanting physicians. A systematic literature search was performed in MEDLINE, EMBASE, and the Cochrane Library to identify clinical trials in patients on chronic oral anticoagulant (OAC) therapy undergoing CIEDs implantation. Bleeding and thromboembolic events were compared among heparin bridging, continued OAC, and interrupted OAC groups. Data were expressed as relative risks (RRs) and 95% confidence intervals (CIs) using random effects model. According to the inclusion criteria, totally 14 studies involving 3,744 patients were identified and included in the study. The heparin bridging group showed a significantly higher risk of bleeding events (relative risk [RR] 3.10, 95% confidence interval [CI], 2.02-4.76, P< 0.00001), especially pocket hematoma (RR 3.58, 95% CI, 2.17-5.91, P < 0.00001), but no significantly lower incidence of thromboembolism (RR 1.16, 95% CI, 0.36-3.67, P = 0.81) compared with OAC continuation group. Meanwhile, both unfractionated heparin-bridged and low-molecular-weight heparin-bridged subgroup exhibited a higher risk of bleeding. There was no significant difference between OAC continuation and OAC interruption group in bleeding (RR 0.90, 95% CI, 0.65-1.24, P = 0.52) and thromboembolic (RR 0.57, 95% CI, 0.16-2.01, P = 0.38) complications. The OAC interruption group had an obviously lower incidence of bleeding in comparison with the heparin bridging group and no statistical significance was observed in thrombus occurrence. Implantation of CIEDs with continuous OAC therapy may offer the best option by combining the lower risk of bleeding with rare thromboembolism compared with heparin bridging and OAC interruption therapy.

show abstract

“…Los diversos estudios publicados, son muy heterogéneos, en cuanto al tipo de patología, la indicación de TACO, el tipo de fármaco utilizado, series de casos, estudios cooperativos o artículos de revisión, por lo cual es difícil extraer conclusiones precisas acerca del manejo perioperatorio en estos pacientes (Tabla 4) 1,2,4,5,[7][8][9][10][11] . Son diferentes los ries-gos de complicaciones en diversas patologías como cirugía ocular, dental, cutánea, traumatológica, cardiaca, patología herniaria, etc 4 .…”

Section: Discussionunclassified

Cirugia Herniaria Electiva en Pacientes Portadores De Tratamiento Anticoagulante

et al. 2019

Rev. Cirugia

View full text Add to dashboard Cite

Introducción: Diversas patologías requieren de tratamiento anticoagulante oral (TACO). Algunos de estos pacientes requieren resolución quirúrgica. El manejo perioperatorio de estos pacientes es variable dependiendo del centro.Objetivos: Evaluar la morbilidad y mortalidad del protocolo de manejo de patología herniaria en TACO, atendidos en nuestro hospital.Material y métodos: Estudio descriptivo prospectivo de 37 pacientes sometidos a cirugía herniaria en TACO entre 2008-2016. Los datos fueron obtenidos de la base de datos computacional del Equipo de Hernias, con un seguimiento mínimo de 1 mes. Se evaluaron las características clínicas, quirúrgicas y la morbimortalidad postoperatoria. El traslape consistió en hospitalizar al paciente tres días previos a la cirugía, suspendiéndose el TACO e iniciando heparina de bajo peso molecular (HBPM) en dosis terapéuticas, que se suspende 24 horas previas a la cirugía. Se reinicia la HPBM a las 12 a 24 horas postoperatorias, y se inicia el traslape a TACO a las 24 – 48 horas. Los datos fueron analizados con Stata v14.Resultados: De los 37 pacientes estudiados, veintiséis pacientes fueron hombres (70,2%), la media de edad fue de 67,3 años. El 48,7% tenían fibrilación auricular. El 100% consumía acenocumarol como TACO. La media en el inicio del traslape a la anticoagulación oral fue de 1,4 días. El promedio de INR al momento del alta fue de 2,04. Dos pacientes fueron dados de alta con dalteparina. Un paciente (2,7%), presentó dolor en el postoperatorio inmediato y uno (2,7%), equimosis del sitio quirúrgico.Conclusiones: El protocolo de trabajo utilizado, demostró ser seguro, con una mínima morbilidad postoperatoria.

show abstract

Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome

Cited by 9 publications

References 16 publications

Factors associated with bleeding complications in hernia repair of warfarin users

Factors associated with bleeding complications in hernia repair of warfarin users

Perioperative Anticoagulation Management in Patients on Chronic Oral Anticoagulant Therapy Undergoing Cardiac Devices Implantation: A Meta‐Analysis

Cirugia Herniaria Electiva en Pacientes Portadores De Tratamiento Anticoagulante

Contact Info

Product

Resources

About