PMID- 14691412
OWN - NLM
STAT- MEDLINE
DCOM- 20040123
LR  - 20190626
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 147
IP  - 1
DP  - 2004 Jan
TI  - Periprocedural thromboprophylaxis in patients receiving chronic anticoagulation 
      therapy.
PG  - 3-15
AB  - 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 for serious bleeding complications, whereas 
      discontinuing anticoagulation puts them at risk of thromboembolic complications. 
      Most patients can undergo dental procedures, cataract surgery, and diagnostic 
      endoscopy without discontinuing anticoagulation. The main patient groups that may 
      require a periprocedural alternative to oral anticoagulation (periprocedural 
      thromboprophylaxis or bridging) include patients with prosthetic heart valves, 
      atrial fibrillation, and hypercoagulable states and patients with chronic venous 
      thrombosis who are undergoing surgery. Currently, there is little consensus on 
      the appropriate perioperative treatment of patients on long-term warfarin 
      therapy. There are an increasing number of studies that evaluate the benefits of 
      periprocedural bridging with low-molecular-weight heparin (LMWH) in place of 
      unfractionated heparin (UFH). An advantage of LMWH over UFH is that perioperative 
      conversion from warfarin therapy with LMWH can be carried out in the outpatient 
      setting, which is more convenient for patients and is cost effective. As with the 
      use of UFH, there are reports of maternal thromboembolic complications with LMWHs 
      in pregnant women with mechanical heart valves. This review brings together the 
      available data on periprocedural bridging to assess the available options for 
      patients on long-term warfarin therapy who are undergoing surgical procedures. It 
      provides a rationale for using LMWHs while individualizing the risks versus 
      benefits in a given patient population.
FAU - Jafri, Syed M
AU  - Jafri SM
AD  - Department of Cardiology, Henry Ford Hospital, Detroit, Mich 48202, USA. 
      SJAFRI2@hfhs.org
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Contraindications
MH  - Electric Countershock/adverse effects
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Oral Surgical Procedures/adverse effects
MH  - Pregnancy
MH  - Pregnancy Complications, Cardiovascular/etiology
MH  - Risk Factors
MH  - Surgical Procedures, Operative/*adverse effects
MH  - Thromboembolism/etiology/*prevention & control
MH  - Warfarin/therapeutic use
RF  - 73
EDAT- 2003/12/24 05:00
MHDA- 2004/01/24 05:00
CRDT- 2003/12/24 05:00
PHST- 2003/12/24 05:00 [pubmed]
PHST- 2004/01/24 05:00 [medline]
PHST- 2003/12/24 05:00 [entrez]
AID - aS0002870303005891 [pii]
AID - 10.1016/j.ahj.2003.06.001 [doi]
PST - ppublish
SO  - Am Heart J. 2004 Jan;147(1):3-15. doi: 10.1016/j.ahj.2003.06.001.