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Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery

BACKGROUND: Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleedin...

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Autores principales: Lock, J. F., Ungeheuer, L., Borst, P., Swol, J., Löb, S., Brede, E. M., Röder, D., Lengenfelder, B., Sauer, K., Germer, C.-T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682086/
https://www.ncbi.nlm.nih.gov/pubmed/33292504
http://dx.doi.org/10.1186/s13741-020-00170-4
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author Lock, J. F.
Ungeheuer, L.
Borst, P.
Swol, J.
Löb, S.
Brede, E. M.
Röder, D.
Lengenfelder, B.
Sauer, K.
Germer, C.-T.
author_facet Lock, J. F.
Ungeheuer, L.
Borst, P.
Swol, J.
Löb, S.
Brede, E. M.
Röder, D.
Lengenfelder, B.
Sauer, K.
Germer, C.-T.
author_sort Lock, J. F.
collection PubMed
description BACKGROUND: Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. METHODS: We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. RESULTS: A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8% vs. 1%; p < 0.001) as well as minor bleeding events (14% vs. 5%; p < 0.001). Thromboembolic events were equally rare in both groups (1% vs. 2%; p = 0.45). No effect on mortality was observed (1.5% vs. 1.9%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. CONCLUSION: Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging.
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spelling pubmed-76820862020-11-23 Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery Lock, J. F. Ungeheuer, L. Borst, P. Swol, J. Löb, S. Brede, E. M. Röder, D. Lengenfelder, B. Sauer, K. Germer, C.-T. Perioper Med (Lond) Research BACKGROUND: Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. METHODS: We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. RESULTS: A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8% vs. 1%; p < 0.001) as well as minor bleeding events (14% vs. 5%; p < 0.001). Thromboembolic events were equally rare in both groups (1% vs. 2%; p = 0.45). No effect on mortality was observed (1.5% vs. 1.9%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. CONCLUSION: Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging. BioMed Central 2020-11-23 /pmc/articles/PMC7682086/ /pubmed/33292504 http://dx.doi.org/10.1186/s13741-020-00170-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Lock, J. F.
Ungeheuer, L.
Borst, P.
Swol, J.
Löb, S.
Brede, E. M.
Röder, D.
Lengenfelder, B.
Sauer, K.
Germer, C.-T.
Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title_full Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title_fullStr Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title_full_unstemmed Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title_short Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
title_sort markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682086/
https://www.ncbi.nlm.nih.gov/pubmed/33292504
http://dx.doi.org/10.1186/s13741-020-00170-4
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