title: Tonsillectomy in the anticoagulated patient.
abstract: OBJECTIVE
  The objectives of this study were to review perioperative bridging strategies for anticoagulated patients and to describe a novel bridging strategy for tonsillectomy in an anticoagulated patient that addresses both primary and secondary hemorrhage risks.
  
  
  METHODS
  A literature review and a case report are presented. PubMed was reviewed for evidence-based recommendations on perioperative management of anticoagulated patients. A case report is detailed of a 28-year-old woman with antiphospholipid syndrome on warfarin for high risk of venous thrombosis who underwent tonsillectomy. A perioperative bridging strategy incorporating outpatient low-molecular weight heparin and inpatient unfractionated heparin was implemented to minimize risks of thrombosis and primary and secondary posttonsillectomy hemorrhage.
  
  
  RESULTS
  Limited evidence supports a consensus on the best perioperative management of anticoagulated patients. Tonsillectomy in an anticoagulated patient has not been described previously. The patient in this case underwent successful tonsillectomy with no thrombosis or bleeding after 1 month of follow-up.
  
  
  CONCLUSIONS
  Tonsillectomy can be done relatively safely in an anticoagulated patient at high risk for thrombosis. The perioperative bridging strategy should account for its unique risk of primary and secondary postoperative hemorrhage. A proposed algorithm for managing these competing risks is presented.
authors.affiliation: Department of Otolaryngology, Naval Medical Center San Diego, CA 92134, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Cole
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Patterson
authors.forename: Craig L
authors.initials: CL
authors.lastname: Cupp
mesh_terms: D000328:Adult; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008134:Long-Term Care; D019990:Perioperative Care; D000039:Peritonsillar Abscess / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D012307:Risk Factors; D014068:Tonsillectomy / Q000379:methods*; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin