Published in:
01-11-2011 | Original Article
Bleeding and Thromboembolic Outcomes for Patients on Oral Anticoagulation Undergoing Elective Colon and Rectal Abdominal Operations
Published in: Journal of Gastrointestinal Surgery | Issue 11/2011
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Purpose
Patients on chronic oral anticoagulation can be challenging to manage in the perioperative period.
Methods
Review of patients on warfarin undergoing elective abdominal colon and rectal operations at a single institution from 2000 to 2006.
Results
One forty-six patients underwent 165 abdominal procedures. Mean (±SEM) age was 67 ± 1 years; 59% of patients were men. Median estimated blood loss was 200 ml, and 19% received intraoperative blood products while 19% of patients received a postoperative transfusion. Sixteen patients (10%) experienced bleeding complications (three requiring reoperation). No risk factors for bleeding were identified by multivariate analysis (MVA). Five patients (3%) suffered a postoperative thromboembolic event. Preoperative anticoagulation for cerebrovascular disease was a risk factor for thromboembolism (p = 0.03). Overall operative morbidity was 30% with no identifiable risk factor in MVA. Mortality was nil.
Conclusion
Postoperative bleeding and thromboembolism in patients on chronic anticoagulation are not insignificant (10% and 3%, respectively). Patients on warfarin for cerebrovascular disease are at increased risk for thromboembolic events postoperatively and should be placed on appropriate prophylaxis and monitored.