Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy.

Abstract

BACKGROUND AND AIMS:

Among patients on long-term anticoagulant therapy who undergo laparoscopic cholecystectomy (LC), bleeding complications have not been extensively investigated. The objective of this study was therefore to investigate postoperative bleeding complications prospectively in patients on chronic oral anticoagulation.

MATERIALS AND METHODS:

In the period of January 2002 to December 2007, 44 patients on long-term anticoagulation with warfarin, an oral anticoagulant (OAC), underwent LC in our center. Oral anticoagulant was discontinued 5 days before the planned date of surgery, and patients were admitted to the hospital 3 days before. Upon admission, bridging anticoagulation with enoxaparin, a low molecular weight heparin (LMWH), was started. When their international normalized ratio (INR) decreased to <1.5, patients underwent LC. In the absence of postoperative bleeding complications, OAC and LMWH were resumed on the evening of the day of surgery, and LMWH was continued until each patient's target INR was reached. A comparison group was comprised by 1,421 consecutively enrolled patients with no comorbid disease who underwent LC during the same period.

RESULTS:

In the comparison group, postoperative bleeding was encountered in 21 patients (1.5%). In the anticoagulation group, postoperative bleeding was encountered in 11 patients (25%) and ranged from minor oozing from a port incision in one patient to hemorrhage, sepsis, and fatality in one patient. In the anticoagulation group, no significant differences were found between patients with and without postoperative bleeding in terms of age, gender, body mass index, American Society of Anesthesiologists score, INR, or other hemostasis parameters.

CONCLUSIONS:

In patients who underwent LC with bridging anticoagulation, postoperative bleeding was markedly more frequent than expected and was not predicted by the usual coagulation parameters. This suggests a need for methods that can indicate which patients on long-term anticoagulation are at risk for postoperative bleeding.

• Authors: Metin Ercan, Erdal B Bostanci, Ilter Ozer, Murat Ulas, Yusuf B Ozogul, Zafer Teke, Musa Akoglu
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 395 Issue 3 Pg. 247-53 (Mar 2010) ISSN: 1435-2451 [Electronic] Germany
• PMID: 19294412 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Anticoagulants
• Warfarin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (adverse effects)
• Cholecystectomy, Laparoscopic (adverse effects)
• Cohort Studies
• Elective Surgical Procedures
• Female
• Humans
• Male
• Middle Aged
• Postoperative Hemorrhage (etiology)
• Prospective Studies
• Warfarin (adverse effects)