title: Perioperative transient ischemic attack caused by the cessation of warfarin.
abstract: This paper describes the circumstances of a patient who had been receiving long-term warfarin treatment, but ceased it prior to surgical operation, sustained a transient ischemic heart attack post-operatively, which eventuated in delayed extubation and locked-in syndrome. For patients at low risk of perioperative bleeding, anticoagulation with oral vitamin K antagonist can probably be able to maintain the therapeutic range (INR ≤ 2.0) extreme. For patients with a high risk of bleeding, the international normalized ratio (INR) should be kept ≤ 1.5. Within this range, patients at low risk of thrombosis can discontinue warfarin treatment for 2-5 days pre-operatively; patients at high risk for thrombosis can stop warfarin but should probably be treated with intravenous or subcutaneous heparin when the INR is subtherapeutic.
authors.affiliation: Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Sing-Ong
authors.initials: SO
authors.lastname: Lee
authors.forename: Min-Jia
authors.initials: MJ
authors.lastname: Li
authors.forename: Hsin-Ming
authors.initials: HM
authors.lastname: Ho
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Chien
authors.forename: Shu-Lin
authors.initials: SL
authors.lastname: Guo
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D059035:Perioperative Period; D013375:Substance Withdrawal Syndrome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin