title: Bleeding and thromboembolic outcomes for patients on oral anticoagulation undergoing elective colon and rectal abdominal operations.
abstract: OBJECTIVE
  Patients on chronic oral anticoagulation can be challenging to manage in the perioperative period.
  
  
  METHODS
  Review of patients on warfarin undergoing elective abdominal colon and rectal operations at a single institution from 2000 to 2006.
  
  
  RESULTS
  One forty-six patients underwent 165 abdominal procedures. Mean (±SEM) age was 67 ± 1 years; 59% of patients were men. Median estimated blood loss was 200 ml, and 19% received intraoperative blood products while 19% of patients received a postoperative transfusion. Sixteen patients (10%) experienced bleeding complications (three requiring reoperation). No risk factors for bleeding were identified by multivariate analysis (MVA). Five patients (3%) suffered a postoperative thromboembolic event. Preoperative anticoagulation for cerebrovascular disease was a risk factor for thromboembolism (p = 0.03). Overall operative morbidity was 30% with no identifiable risk factor in MVA. Mortality was nil.
  
  
  CONCLUSIONS
  Postoperative bleeding and thromboembolism in patients on chronic anticoagulation are not insignificant (10% and 3%, respectively). Patients on warfarin for cerebrovascular disease are at increased risk for thromboembolic events postoperatively and should be placed on appropriate prophylaxis and monitored.
authors: Mayo Clinic Division of Colon and Rectal Surgery, Rochester, MN 55905, USA.
authors: Corey W
authors: CW
authors: Iqbal
authors: Robert R
authors: RR
authors: Cima
authors: John H
authors: JH
authors: Pemberton
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000601:surgery; D012002:Rectal Diseases / Q000601:surgery*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin