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(Circulation. 2004;110:1518-1519.)
© 2004 American Heart Association, Inc.

Editorial

Anticoagulation Interruptus

Not Without Risk

Michael D. Ezekowitz, MBChB, DPhil, FRCP

From Drexel University College of Medicine, Philadelphia, Pa.

Correspondence to Michael D. Ezekowitz, MBChB, DPhil, FRCP, June F. Klinghoffer Professor, Drexel University College of Medicine, 245 N 15th St, MS 470, Rm 6608 NCB, Philadelphia, PA 19102. E-mail michael.ezekowitz@drexel.edu

Key Words: Editorials • anticoagulants • coagulation • hemorrhage

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The need to withhold anticoagulation in patients requiring elective surgery poses a particularly important challenge when the risk of thrombosis and thromboembolism is high. In spite of the increasing use of prosthetic heart valves and the increasing prevalence of atrial fibrillation in the aging population, Kovacs et al¹ make the important point in this issue of Circulation that there is a paucity of information in the literature to guide the clinician to optimal care. This observation motivated the design of the prospective study they report. Patients’ anticoagulation therapy was discontinued before surgery. There were 3 reporting phases: preoperative, intraoperative, and postoperative.

See p 1658

In the preoperative phase, warfarin was stopped 5 days before the procedure and replaced with dalteparin, a low-molecular-weight heparin administered at a dose of 200 IU/kg on the mornings of the third and second days before the procedure. On the morning of surgery, dalteparin was administered at 100 IU/kg. For patients whose international normalized ratio (INR) was >1.4 on the day before surgery, 1 mg oral vitamin K was prescribed. For those patients requiring vitamin K, INR measurement was repeated the day of surgery, and if >1.4, postponement of surgery was considered. Aspirin was stopped 7 days before the surgery. The major positive finding of the paper is that this regimen worked; there were no bleeding or valve thromboses or thromboembolic complications.

Phases 2 and 3 provide more questions than answers. During surgery, the authors report "bleeding complications," which were used as a reason for not . . . [Full Text of this Article]

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