Postoperative anticoagulation in vascular surgery: part 1. A retrospective comparison of clinical outcomes for unfractionated heparin versus low-molecular-weight heparin.
The use of postoperative anticoagulation is not uncommon for patients undergoing vascular procedures, whether for adjunctive therapy to the surgical procedure or for resumption of preoperative anticoagulation. Longer postoperative length of stay is necessary to achieve an adequate therapeutic international normalized ratio with traditional protocols that call for the use of unfractionated heparin. We retrospectively examined 195 cases to determine whether low-molecular-weight heparin, specifically enoxaparin, was an effective postoperative replacement for intravenous unfractionated heparin, with the impact on postoperative length of stay. There was no difference in the frequency of complications except for increased incidence of return to surgery for graft thrombosis (n = 11) in patients who received traditional intravenous unfractionated heparin with adjusted-dose warfarin daily (n = 139, P <.02). For all 195 vascular procedures combined, the average postoperative length of stay with use of enoxoparin was shortened with use of enoxaparin (P <.0008). There was a 2-day reduction in the average postoperative length of stay for the femoral-distal procedure group (n = 18, P <.004). In the first part of the article, we summarize our findings and offer new applications and ideas for vascular nurses to consider when postoperative anticoagulation is indicated after vascular procedures. Factors contributing to safe and efficacious postoperative anticoagulation with use of low-molecular-weight heparin, specifically enoxaparin, are presented to the vascular nurse. In the second part, we discuss the roles of members of the vascular team, as well as our experience with use of enoxaparin as implemented in the clinical setting.
Gramse
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Department of Vascular Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Hingorani
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Ascher
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing; D017984:Enoxaparin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods* / Q000451:nursing* / Q000592:standards; D012189:Retrospective Studies; D012449:Safety; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin