Perioperative transient ischemic attack caused by the cessation of warfarin.

Abstract

This paper describes the circumstances of a patient who had been receiving long-term warfarin treatment, but ceased it prior to surgical operation, sustained a transient ischemic heart attack post-operatively, which eventuated in delayed extubation and locked-in syndrome. For patients at low risk of perioperative bleeding, anticoagulation with oral vitamin K antagonist can probably be able to maintain the therapeutic range (INR ≤ 2.0) extreme. For patients with a high risk of bleeding, the international normalized ratio (INR) should be kept ≤ 1.5. Within this range, patients at low risk of thrombosis can discontinue warfarin treatment for 2-5 days pre-operatively; patients at high risk for thrombosis can stop warfarin but should probably be treated with intravenous or subcutaneous heparin when the INR is subtherapeutic.

• Authors: Sing-Ong Lee, Min-Jia Li, Hsin-Ming Ho, Chih-Cheng Chien, Shu-Lin Guo
• Journal: Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists (Acta Anaesthesiol Taiwan) Vol. 48 Issue 4 Pg. 188-90 (Dec 2010) ISSN: 1875-452X [Electronic] China (Republic : 1949- )
• PMID: 21195993 (Publication Type: Case Reports, Journal Article)
• Copyright: Taiwan Society of Anesthesiologists, Publised by Elsevier Taiwan LLC, All rights reserved.

Chemical References

• Anticoagulants
• Warfarin

Topics

• Aged
• Anticoagulants (administration & dosage)
• Female
• Humans
• Ischemic Attack, Transient (etiology)
• Perioperative Period
• Substance Withdrawal Syndrome
• Warfarin (administration & dosage)