Background: Withdrawal of anticoagulation around surgery and medical procedures presents risks of bleeding and thrombosis. There is also the risk of cancellation of vital procures due to anticoagulation not being withdrawn appropriately or inadequate coordination and communication between the anticoagulation team and operating teams.
Aims: An established service to ensure appropriate peri-operative anticoagulation and follow up was audited to establish rates of cancellation, numbers of peri operative thrombotic events and post procedure bleeding events.
Methods: Referrals are made electronically by the pre-operative assessment nurses for all anticoagulated patients requiring surgery in the hospital. A peri-operative anticoagulation plan is created by the anticoagulation specialist nurses on a database. The plans are approved by the lead specialist nurse or the lead consultant haematologist. The plan is uploaded to electronic records for review by surgical teams.
The patient is phoned by the anticoagulation nurses 1-2 weeks pre procedure and informed of the date they are to stop their oral anticoagulation. All patients taking Warfarin are given a 2-3 day pre-operative appointment where the INR is checked and bridging commenced with injectable anticoagulants if indicated. Those requiring bridging are taught self-injection or community nursing support is arranged. Oral vitamin K is administered to those who have an INR >2.0 at the appointment.
Post-operative follow up is arranged.
The patients were phoned by the anticoagulation nurses post procedure to audit the following:
- Procedure cancellation rates.
- Adherence to peri-operative plan.
- Peri-operative thrombosis rates
- Post-operative bleeding rates
Results: Patients adhered to recommended plans well
Cancellation of procedure was almost always not related to anticoagulation but other reasons.
Thrombosis rates were negligible.
Severity and character of bleeding was noted.
- Patient peri-operative adherence was good
- Cancellation of procedures due to anticoagulation was prevented
- Peri-operative thrombosis was not a problem
- Post-operative bleeding occurred only among those bridged with low molecular weight heparin.
To cite this abstract in AMA style:Priest P, Kadam A, Moghaddam L, Kashani N, Drebes A, Morjaria P, Bates S. A Nurse Led Service Providing Safe and Effective Peri-Operative Anticoagulation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-nurse-led-service-providing-safe-and-effective-peri-operative-anticoagulation/. Accessed January 26, 2022.
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