title: Periprocedural Anticoagulation Management of Patients with Thrombophilia.
abstract: Appropriate periprocedural management of the chronically anticoagulated patient with an inherited or acquired thrombophilia is uncertain. The objective of this study was to test "thrombophilia" as a potential predictor of the 3-month cumulative incidence of thromboembolism and major bleeding among chronically anticoagulated patients undergoing an invasive procedure.
  
  
  
  In a prospective cohort study, consecutive chronically anticoagulated patients referred to the Mayo Thrombophilia Center for standardized periprocedural anticoagulation management who had venous thromboembolism and complete thrombophilia testing were categorized as "severe," "non-severe," or "no identifiable" thrombophilia. The 3-month cumulative incidence rates of thromboembolism, bleeding, and death were estimated using the Kaplan-Meier product limit method.
  
  
  
  Among 362 patients with complete thrombophilia testing, 165 (46%) had a defined thrombophilia; 76 patients had severe thrombophilia, mainly due to antiphospholipid syndrome (66%). Half of the patients in each of the 3 groups received pre- and postprocedure heparin. During follow-up, there were no thromboembolic events, rare major bleeding events (1% for each group), and 4 deaths. Due to the very low event rates for each of these outcomes, Cox proportional hazard modeling could not be performed.
  
  
  
  Periprocedural event rates were low irrespective of thrombophilia status. Inherited or acquired thrombophilia was not a predictor of thromboembolism, major bleeding, or mortality after temporary interruption of chronic anticoagulation for an invasive procedure.
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Ewa M
authors.initials: EM
authors.lastname: Wysokinska
authors.affiliation: Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Waldemar E
authors.initials: WE
authors.lastname: Wysokinski
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.
authors.forename: Siva
authors.initials: S
authors.lastname: Ketha
authors.affiliation: Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Scott
authors.initials: S
authors.lastname: Litin
authors.affiliation: Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn.
authors.forename: Paul
authors.initials: P
authors.lastname: Daniels
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: Joshua
authors.initials: J
authors.lastname: Slusser
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minn; Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
authors.forename: John A
authors.initials: JA
authors.lastname: Heit
authors.affiliation: Mayo Clinic Thrombophilia Center, Gonda Vascular Center, Mayo Clinic, Rochester, Minn. Electronic address: mcbane.robert@mayo.edu.
authors.forename: Robert D
authors.initials: RD
authors.lastname: McBane
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D019851:Thrombophilia / Q000150:complications*; D054556:Venous Thromboembolism / Q000150:complications / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Bridging; Periprocedural anticoagulation management; Thrombophilia; Venous thromboembolism