Perioperative anticoagulation in patients with mechanical heart valves undergoing elective surgery: Results of a survey conducted among Korean physicians

Doyeun Oh, Sehyun Kim, Chang Young Lim, Jong-Seok Lee, Seonyang Park, David Garcia, Mark A. Crowther, Walter Ageno

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

The optimal perioperative anticoagulation management in patients on warfarin therapy is poorly defined due to the lack of randomized trials. Because guidelines are heterogeneous, it was hypothesized that "treatment strategies are not uniform in clinical practice". Between February 2003 and May 2003, a questionnaire with 4 different clinical scenarios was distributed to physicians by e-mail, or direct contact was made by a survey monitor. Two scenarios described the cases of patients with a mechanical heart valve (MHV) in the mitral position, with additional risk factors for a systemic embolism; one undergoing major (scenario 1) and the other minor surgery (scenario 3). Two scenarios described patients with an aortic MHV; one undergoing major (scenario 2) and the other minor (scenario 4) surgery. Different preoperative and postoperative management options were offered. The treatment options for all scenarios were the same. Of the 90 questionnaires distributed, 52 (57.8%) were returned. Hospitalization for full-dose intravenous unfractionated heparin (IV UH) was the most commonly selected strategy in the preoperative phase for scenarios 1 (59%), 2 (42%) and 3 (44%). In scenario 4, 34% chose IV UH. Outpatient, full-dose, subcutaneous UH or low-molecular-weight heparin (LMWH) was the most selected option in the postoperative phase for all scenarios, with the exception of number 4 (52.9% in scenario 1, 34% in scenario 2, 32%, in scenario 3 and 28% in scenario 4). Even among expert clinicians, the management of perioperative anticoagulation is heterogeneous. In particular, the definition of risk categories and the optimal intensity of antithrombotic drugs need to be defined by well-designed prospective studies.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalYonsei Medical Journal
Volume46
Issue number1
DOIs
StatePublished - 28 Feb 2005

Fingerprint

Heart Valves
Physicians
Heparin
Minor Surgical Procedures
Low Molecular Weight Heparin
Postal Service
Warfarin
Embolism
Hospitalization
Outpatients
Therapeutics
Prospective Studies
Guidelines
Pharmaceutical Preparations
Surveys and Questionnaires

Keywords

  • Mechanical heart valve
  • Perioperative anticoagulation

Cite this

Oh, Doyeun ; Kim, Sehyun ; Lim, Chang Young ; Lee, Jong-Seok ; Park, Seonyang ; Garcia, David ; Crowther, Mark A. ; Ageno, Walter. / Perioperative anticoagulation in patients with mechanical heart valves undergoing elective surgery : Results of a survey conducted among Korean physicians. In: Yonsei Medical Journal. 2005 ; Vol. 46, No. 1. pp. 66-72.
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Perioperative anticoagulation in patients with mechanical heart valves undergoing elective surgery : Results of a survey conducted among Korean physicians. / Oh, Doyeun; Kim, Sehyun; Lim, Chang Young; Lee, Jong-Seok; Park, Seonyang; Garcia, David; Crowther, Mark A.; Ageno, Walter.

In: Yonsei Medical Journal, Vol. 46, No. 1, 28.02.2005, p. 66-72.

Research output: Contribution to journalArticle

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