Perioperative Safety of Warfarin Therapy and Reversal
| Autor: | Erin Springer, Benjamin Maslin, Richard Zhu, Vijay Kodumudi, Nalini Vadivelu |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Population Warfarin therapy MEDLINE Hemorrhage Toxicology Perioperative Care Patient safety Risk Factors medicine Humans Pharmacology (medical) education Intensive care medicine Pharmacology Clinical Trials as Topic education.field_of_study business.industry Warfarin Anticoagulants Retrospective cohort study Perioperative Clinical trial business medicine.drug |
| Zdroj: | Current Drug Safety. 11:149-155 |
| ISSN: | 1574-8863 |
| DOI: | 10.2174/1574886311666151217121553 |
| Popis: | Background Warfarin is the most widely prescribed oral anticoagulant frequently encountered in the patients presenting for both elective and emergent surgery. Maintaining therapeutic levels of warfarin therapy may increase the risk of blood loss and procedural complications, including complications from neuraxial and regional anesthetic techniques. However, in some vulnerable patient groups, discontinuing therapy may result in negative thromboembolic consequences. Objective To review the published guidelines and supporting data from clinical studies addressing the safe and coordinated management of patients on warfarin therapy who present for perioperative care. Method This review highlights the most up-to-date research from clinical trials as well as from retrospective studies in addition to multidisciplinary consensus guidelines regarding the safety of warfarin therapy and reversal in the perioperative period. Results Based on the most up-to-date literature, certain patient groups may be more vulnerable to cessation of warfarin therapy before surgery and there exists a risk stratification algorithm. In many other cases, particularly emergent surgery, it may be necessary to reverse warfarin therapy preoperatively. There are anesthetic, surgical and safety implications in these clinical decision points. Conclusion With the aging of the United States population, the prevalence of preoperative patients therapeutic on warfarin will continue to increase, necessitating the multidisciplinary and coordinated care of perioperative clinicians to ensure patient safety and optimize clinical outcomes. |
| Databáze: | OpenAIRE |
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