Background: Patients with oral anticoagulation therapy (OAT) with vitamin K antagonists (VKA) undergo invasive procedures. Deciding wether to withdraw or maintain the OAT, as well as the needing to implement low molecular weight heparin (LMWH) as bridge therapy (BT), will be determined by the patient’s thrombotic risk (TR) and surgery’s haemorrhagic risk (HR).
Aims: To decrease bleeding events related to surgery by limiting the use of LMWH with patients having high TR.
Methods: Prospective, unicentric, observational study including 200 patients with OAT undergoing surgery (December 2019-February 2021), with 4 weeks of follow-up. The median age is 73 (33-93). Most patients are low TR on CHADs-VASc score. OAT periprocedural management was in accordance with the approved hospital protocol which classifies patients according to TR (Table 1) and surgeries according to HR . VKA is suspended 3 days before surgery and resumed 24 hours after. LMWH as BT is reserved for patients with high TR or suspected active cancer (therapeutic dose), starting with OAT suspension and reintroduced along with it 24 hours after surgery for 3 days (if no bleeding complications).
Results: Interventions and clinical events during the follow-up are shown in Table 2.
Eleven post-surgical haemorrhagic events (5,5%) are described[GJ1] . Three (two hemoperitoneum and one haematoma of anterior rectus abdominis muscle) required hospitalisation for management, being solved with conservative treatment. Eight were mild events, handled outpatiently. No thrombotic events were recorded. Generally, OAT was re-induced the day after surgery in patients undergoing minimal and low HR interventions, being the percentage lower in patients undergoing high HR interventions
Conclusions: The standardization of periprocedural management protocol for OAT adjusting BT with LMWH according to individual risk factors for each patient resulted in a reduction in the incidence of haemorrhagic complications without secondary increase of thromboembolic events. This study demonstrates the importance of a central, unified periprocedural management protocol.
To cite this abstract in AMA style:Argüello Marina M, Gutiérrez Jomarrón I, Castilla García L, Flores Ballester E, Sánchez Prieto I, Valenciano Martínez S, Aspa Cilleruelo JM, Martínez Vázquez C, López de Hontanar Torres G, Rodríguez Barquero PA, López Rubio M, García Suárez J. Incidence of Thrombohaemorrhagic Complications in the Periprocedural of Oral Anticoagulant Treatment with Vitamin K Antagonists [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/incidence-of-thrombohaemorrhagic-complications-in-the-periprocedural-of-oral-anticoagulant-treatment-with-vitamin-k-antagonists/. Accessed September 23, 2021.
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