title: Perioperative management of chronic anticoagulation therapy in urological patients: a cross-sectional survey of practice.
abstract: BACKGROUND
  There has been a significant increase in the volume of urological patients on daily anticoagulation therapy requiring invasive elective urological procedures.
  
  
  OBJECTIVE
  We sought to assess whether urologists are familiar with appropriate perioperative management strategies in this patient cohort.
  
  
  METHODS
  Urologists completed a questionnaire on their current management strategy for warfarin during the perioperative period in patients undergoing elective urological surgery. Eleven urological procedures graded as minor, endoscopic and major were assessed in the study. In addition, respondents were also asked whether they administered bridging therapy with heparin when warfarin was discontinued perioperatively.
  
  
  RESULTS
  The response rate was 52.5% (210/400). Procedure grade did not influence the duration warfarin was discontinued preoperatively with respondents discontinuing the agent 4.71 ± 1.52 days (range 2-10 days) prior to minor procedures, 4.74 ± 1.43 days (range 2-10 days) prior to endoscopic procedures and 4.88 ± 1.34 days (range 2-10 days) prior to major procedures (p > 0.05). Postoperatively, procedure grade significantly affected the day to recommencement with respondents recommencing warfarin 2.41 ± 2.31 days (range 1-14 days) after minor procedures, 3.07 ± 3.52 days (range 1-28 days) after endoscopic procedures and 4.38 ± 3.53 days (range 1-14 days) after major procedures (p < 0.0001). In total, 60 ± 0.52% of the respondents who discontinued warfarin routinely administered bridging therapy with heparin perioperatively.
  
  
  CONCLUSIONS
  Our study demonstrates variations in perioperative management practices for patients on chronic anticoagulation therapy undergoing urological procedures. Urologists should familiarise themselves with standardised guidelines if this patient subgroup are to receive optimal perioperative management.
authors.affiliation: Department of Urology, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. nialldavis2001@yahoo.com
authors.forename: N F
authors.initials: NF
authors.lastname: Davis
authors.forename: D M
authors.initials: DM
authors.lastname: Fanning
authors.forename: B B
authors.initials: BB
authors.lastname: McGuire
authors.forename: G T
authors.initials: GT
authors.lastname: Carroll
authors.forename: H D
authors.initials: HD
authors.lastname: Flood
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D019990:Perioperative Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013997:Time Factors; D013520:Urologic Surgical Procedures; D014572:Urology; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin