Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Watzke, H; Metzler, H; Weltermann, A; Marschang, P; Brodmann, M; Lang, W; Pabinger-Fasching, I; Mahla, E; Kozek-Langenecker, S; Guschmann, M; Huber, K.
Periprocedual management of vitamin K antagonist's with low molecular weight heparins during invasive procedures--Consensus of experts].
Wien Klin Wochenschr. 2013; 125(13-14):412-420
Doi: 10.1007/s00508-013-0390-7
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Brodmann Marianne
- Mahla Elisabeth
- Metzler Helfried
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- Abstract:
- Interruption of an ongoing therapy with vitamin K antagonists (VKAs) is necessary in almost all patients undergoing major surgery. The purpose of the following expert recommendations is to provide easy to use guidance for the periprocedural management of patients on VKAs based on current evidence from the literature. Management of anticoagulation during the time of interruption of VKAs is based on balancing the thromboembolic (TE) risk of underlying conditions against the bleeding risk of the surgical procedure. VKAs should be stopped 3–7days prior to surgery. Low molecular weight heparin (LMWH) is used to cover (“bridge”) the progressive pre-operative loss of anticoagulation and the slow post-operative onset of anticoagulant activity of VKAs. Patients with high risk of TE should receive a therapeutic dose of LMWH, patients with a moderate risk of TE should receive half of this dose. Patients with a low risk of TE do not need bridging therapy with LMWH. In case of an uneventful postoperative course, patients with a therapeutic pre-operative dose should be treated post-operatively with the same dose, starting on day 4 in case of major surgery and on day 2 in case of minor procedures. Patients with a half-therapeutic preoperative dose should be treated post-operatively with the same dose, starting on day 3 in case of major surgery and on day 1 in case of minor procedures. Therapy with VKAs should be re-instituted on the second post-operative day based on the preoperative dosage. Procedure-related post-operative thromboprophylaxis should be given irrespective of these recommendations on days without “bridging” anticoagulation.
- Find related publications in this database (using NLM MeSH Indexing)
- General Surgery - standards
- General Surgery -
- Heparin, Low-Molecular-Weight - administration & dosage Heparin, Low-Molecular-Weight - adverse effects
- Humans -
- Intraoperative Care - standards
- Postoperative Hemorrhage - chemically induced Postoperative Hemorrhage - prevention & control
- Practice Guidelines as Topic -
- Thromboembolism - chemically induced Thromboembolism - prevention & control
- Find related publications in this database (Keywords)
- Antithrombotic therapy
- Bridging
- Anticoagulation
- Periprocedural management
- Low molecular weight heparin
- Enoxaparin
- Lovenox