title: A Korean Multi-Center Survey about Warfarin Management before Gastroenterological Endoscopy in Patients with a History of Mechanical Valve Replacement Surgery.
abstract: BACKGROUND
  Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases.
  
  
  METHODS
  The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios.
  
  
  RESULTS
  Thirty-six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient's INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement.
  
  
  CONCLUSIONS
  This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Kuk Hui
authors.initials: KH
authors.lastname: Son
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Chang-Hyu
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Jae-Ik
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Kun Woo
authors.initials: KW
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: So Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Kook Yang
authors.initials: KY
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine.
authors.forename: Chul Hyun
authors.initials: CH
authors.lastname: Park
keywords: Anticoagulants; Endoscopy; Heart valve prosthesis; Hemorrhage; Thromboembolism