title: Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience.
abstract: OBJECTIVE
  To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery.
  
  
  METHODS
  A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it.
  
  
  RESULTS
  A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal).
  
  
  CONCLUSIONS
  Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events.
authors.affiliation: Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. Electronic address: anaflorenciabecerra@yahoo.com.ar.
authors.forename: Ana Florencia
authors.initials: AF
authors.lastname: Becerra
authors.affiliation: Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: María Teresita
authors.initials: MT
authors.lastname: Cornavaca
authors.affiliation: Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Revigliono
authors.affiliation: Servicio de Cardiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Contreras
authors.affiliation: Servicio de Clínica Médica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Albertini
authors.affiliation: Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina; Servicio de Medicina Vascular y Trombosis, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
authors.forename: Aldo Hugo
authors.initials: AH
authors.lastname: Tabares
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Antagonistas de vitamina K; Anticoagulación; Anticoagulation; Atrial fibrillation; Embolia; Embolism; Fibrilación auricular; Perioperative management; Perioperatorio; Thrombosis; Trombosis; Vitamin K antagonists