The effect of stopping phenprocoumon 5 days preoperatively: A retrospective study.
anticoagulant
international normalized ratio
phenprocoumon
preoperative care
vitamin k antagonists
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
11
01
2018
accepted:
21
09
2018
entrez:
19
1
2019
pubmed:
19
1
2019
medline:
19
1
2019
Statut:
epublish
Résumé
Clinicians lack substantiated guidance on when vitamin K antagonist (VKA) treatment should be interrupted preoperatively, especially with regard to phenprocoumon, with its long half-life of 5.5 days. To evaluate the efficacy of discontinuing phenprocoumon 5 days preoperatively and determine whether a safe international normalized ratio (INR) was reached. This was a retrospective review of 118 patients using phenprocoumon prior to elective surgery. Preoperative INRs and factors that could potentially influence these values were identified and described. A safe preoperative INR was defined as <1.8. Of the 118 included patients, 42 patients (35.6%) had an off-target INR. The male sex was significantly and independently associated with an off-target INR (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.022-5.445). A high American Society of Anesthesiologists (ASA) classification was also significantly and independently associated with an off-target INR (OR 2.3, 95% CI: 1.029-5.173). Discontinuation of phenprocoumon 5 days preoperatively resulted in an INR < 1.8 in more than one-third of patients. Individualizing or extending the period of phenprocoumon discontinuation may be a necessary treatment option.
Sections du résumé
BACKGROUND
BACKGROUND
Clinicians lack substantiated guidance on when vitamin K antagonist (VKA) treatment should be interrupted preoperatively, especially with regard to phenprocoumon, with its long half-life of 5.5 days.
OBJECTIVE
OBJECTIVE
To evaluate the efficacy of discontinuing phenprocoumon 5 days preoperatively and determine whether a safe international normalized ratio (INR) was reached.
METHODS
METHODS
This was a retrospective review of 118 patients using phenprocoumon prior to elective surgery. Preoperative INRs and factors that could potentially influence these values were identified and described. A safe preoperative INR was defined as <1.8.
RESULTS
RESULTS
Of the 118 included patients, 42 patients (35.6%) had an off-target INR. The male sex was significantly and independently associated with an off-target INR (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.022-5.445). A high American Society of Anesthesiologists (ASA) classification was also significantly and independently associated with an off-target INR (OR 2.3, 95% CI: 1.029-5.173).
CONCLUSION
CONCLUSIONS
Discontinuation of phenprocoumon 5 days preoperatively resulted in an INR < 1.8 in more than one-third of patients. Individualizing or extending the period of phenprocoumon discontinuation may be a necessary treatment option.
Identifiants
pubmed: 30656280
doi: 10.1002/rth2.12159
pii: S2475-0379(22)01506-0
pmc: PMC6332713
doi:
Types de publication
Journal Article
Langues
eng
Pagination
85-88Commentaires et corrections
Type : CommentIn
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