Endoscopic sinus surgery in patients receiving anticoagulant or antiplatelet therapy.
BACKGROUND
Endoscopic Sinus Surgery (ESS) has not been studied in patients receiving anticoagulant or antiplatelet therapy. Classifing this procedure into a bleeding risk category needs to be done to safely manage these therapies perioperatively.


METHODS



METHODS
Retrospective case control study of prospectively collected data.


METHODS
Academic tertiary referral center.


METHODS
42 patients receiving anticoagulant therapy who underwent an endoscopic sinus surgery between October 1997 and December 2005, compared to a control group of 42 patients matched for age and gender.


RESULTS
The mean estimated blood loss (EBL) during surgery was slightly higher for the control group without reaching a statistically significant difference (p = 0.14). EBL was significantly higher when more sinuses were opened during surgery (p = 0.001). There was no reported major postoperative bleeding related to anticoagulation. All patients were able to resume their anticoagulation or antiplatelet therapy after the surgery.


CONCLUSIONS
ESS is a safe procedure when performed in patients receiving anticoagulation or antiplatet therapy, and could be classified as a moderate bleeding risk surgery. Stopping the medication prior to the surgery is mandatory. However, anticoagulation could be resumed early postoperatively because it does not seen to increase the risk for bleeding. Perioperative bridging with heparin should only be dictated by the patient's condition, not by the procedure itself.
Sargi
Zoukaa
Z
Department of Otolaryngology, University of Miami-Leonard Miller School of Medicine, Miami, Florida, USA. zsargi@med.miami.edu
Casiano
Roy
R
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002356:Cartilage / Q000601:surgery*; D016022:Case-Control Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors