Perioperative heparin based anticoagulation for patients with a history of cardiac valve replacement / 中华普通外科杂志

ABSTRACT

Objective To explore the safety and effectiveness of using low molecular weight heparin (LMWH) in place of warfarin for anticoagulation in patients with a previous cardiac valve replacement. Methods We reviewed 70 patients hospitalized from Jan 2002 to Apr 2009 undergoing abdominal surgery who have had a previous cardiac valve replacement and had been on warfarin anticoagulation therapy. LMWH began to replace warfarin for anticoagulation 3 clay before the surgery in 33 cases, while the other 37 patients simply ceased to use any anticoagulant since 3 days before the surgery. Postoperative bleeding and embolism risk were compared between these two groups. Results There were 2 patients suffering from postoperative bleeding in the operative field in LMWH group, while there was no postoperative bleeding in patients on anticoagulant suspension group (χ~2=0.641, P>0.05). There was no valve embolism occurred in these two groups. Conclusions It is a safe way to stop using warfarin with LMWH taking the task for perioperative anticoagulation in patients with a history of cardiac valve replacement 3 days before an elective abdominal surgery. This protocol decreases the risk rate of valve embolism not at the expense of increasing postoperative bleeding.