[Surgery in patients treated with anticoagulation during emergency and elective interventions].
Patients under oral anticoagulation with coumarin derivatives have a variable perioperative thromboembolic risk which necessitates continuation of their thromboembolic prophylaxis during elective and emergency surgery. Because of their better handling unfractionated heparin and low-molecular-weight heparins are used most often for this purpose. The overlapping effect of coumarin and heparin therapy requires a close daily monitoring of the clotting inhibition (partial thromboplastin time, thromboplastin time, thrombin time). In elective surgery coumarin therapy is interrupted 2-3 days preoperatively; in emergency cases vitamin K or fresh frozen plasma have to be substituted. Patients under heparin therapy or prophylaxis are easier to handle, because the effect of heparin disappears in a few hours after stopping the treatment. In the immediate postoperative phase the heparin application is interrupted for 6 h because of increased bleeding risk. It is important to take into account additional risk factors like the underlying disease, disturbances of platelet function, liver diseases and renal insufficiency.
Encke
A
A
Klinik für Allgemeinchirurgie, J. W. Goethe-Universität Frankfurt/Main.
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D004630:Emergencies; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D010949:Plasma; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D012306:Risk; D014812:Vitamin K / Q000008:administration & dosage
D000925:Anticoagulants; D014812:Vitamin K