title: The association of excessive warfarin anticoagulation and postoperative ileus after total joint replacement surgery.
abstract: Patients undergoing joint replacement who show signs of ileus in the postoperative period that require insertion of a nasogastric tube (NGT) must be monitored closely to avoid bleeding complications. The diagnosis of postoperative ileus was documented in 40 of 2,526 (1.6%) consecutive joint replacement operations between January 1, 1990, and March 1, 1998, at 1 hospital. Of the 40 patients with postoperative ileus, 34 received warfarin postoperatively. Of these 34 patients, 19 required a NGT for >48 hours, and 15 patients required a NGT for <48 hours or did not require a NGT. Of the 19 patients who required a NGT for >48 hours and who received warfarin anticoagulation, 17 had a prothrombin time of >20 seconds or an international normalized ratio (INR) of >2.0. None of the 15 patients who required a NGT for <48 hours and who received warfarin anticoagulation had a prothrombin time of >20 seconds or an INR of >2.0. This difference was highly statistically significant (P < .001).
authors.affiliation: Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805, USA.
authors.forename: R
authors.initials: R
authors.lastname: Iorio
authors.forename: W L
authors.initials: WL
authors.lastname: Healy
authors.forename: D
authors.initials: D
authors.lastname: Appleby
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D003112:Colonic Pseudo-Obstruction / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007441:Intubation, Gastrointestinal; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin