Seminars in thrombosis and hemostasis
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Semin. Thromb. Hemost. · Dec 2004
ReviewPeriprocedural management of anticoagulation in patients on extended warfarin therapy.
Patients receiving chronic anticoagulation therapy pose a clinical challenge when therapy needs to be interrupted for surgical or invasive procedures. Maintaining anticoagulation places them at risk of serious bleeding complications, whereas discontinuing anticoagulation puts them at risk of thromboembolic complications. ⋯ Currently, there is little consensus on appropriate perioperative management of patients on long-term warfarin therapy. This article is an attempt to bring together all the available data on periprocedural bridging to assess the available options for patients undergoing surgical procedures and to provide a rationale for using low-molecular-weight heparins (LMWHs) while individualizing the risks versus benefits in a given patient population.
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Over recent years, the use of portable coagulation monitors for prothrombin time-International Normalized Ratio (PT-INR) testing has been gaining popularity. Their advantages over traditional methods of monitoring include ease of use, short test duration, faster turnaround time for dosage changes, increased patient convenience by eliminating the need to go to the laboratory for venipuncture, and increased patient-provider interaction. Portable coagulation monitors for PT-INR testing are currently used in various settings, such as anticoagulation clinics, physician offices, at the patient's bedside in hospital wards, and independently by patients at home. ⋯ Various point of care (POC) coagulation monitors have been developed, and many models are commercially available in the United States. Because technology differs among the various devices, accuracy and precision need to be determined for individual devices. The various devices cannot be used interchangeably, and individual device performance cannot be generalized.