Gynaecology| Volume 40, ISSUE 2, P199-204, February 2018

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Patients on Long-Term Warfarin Undergo Gynecological Surgeries: A 10-Year Review of Perioperative Anticoagulation

Published:August 15, 2017DOI:



      The aim of this study was to review our experience with patients having gynaecological surgeries while on long-term anticoagulation and to postulate a better guide for their perioperative management.

      Material and Methods

      A retrospective review of all women on long-term warfarin who underwent gynaecological surgeries from January 2003 to December 2012. Data from medical records including operation reports and inpatient and outpatient charts were reviewed and analyzed.


      Sixty-seven cases from 58 patients were identified. Twenty and 38 patients underwent major and minor gynaecological surgeries, respectively. The incidence of postoperative bleeding was higher after major surgery (4 cases, 20%) than after minor surgery (1 case, 2.1%; P = 0.025). All bleeding complications occurred between postoperative day 3 and day 10. Three patients, who had resumption of warfarin at a lower dose and slowly stepped up, had no bleeding complications. None of our patients developed venous thromboembolic complications. There was one mortality due to septic shock.


      Patients on long-term anticoagulation have a trend of increased bleeding complications after major gynaecological surgeries than in minor gynaecological surgeries. We suggest that delaying resumption of warfarin at a lower dose may have a role in reducing the risk of postoperative bleeding without increasing the risk of venous thromboembolism.



      Cette étude avait pour but d'analyser le traitement de patientes ayant subi une chirurgie gynécologique alors qu'elles étaient sous anticoagulothérapie à long terme et de proposer une meilleure méthode de prise en charge périopératoire.

      Matériaux et Méthodologie

      Nous avons mené une étude rétrospective portant sur des femmes prenant de la warfarine à long terme et ayant subi une chirurgie gynécologique entre janvier 2003 et décembre 2012. Nous avons examiné et analysé les données se trouvant dans leurs dossiers médicaux, y compris celles venant des rapports de chirurgie, des dossiers d'hospitalisation et des dossiers de la clinique externe.


      Nous avons retenu 67 cas de chirurgies, réalisées sur 58 patientes. Vingt patientes ont subi une chirurgie gynécologique majeure, tandis que les 38 autres ont subi une chirurgie mineure. L'incidence de saignements en période postopératoire était plus élevée après une chirurgie majeure (quatre cas; 20 %) qu'après une chirurgie mineure (un cas; 2,1 %; P = 0.025). Toutes les complications hémorragiques sont survenues entre le troisième et le dixième jour suivant la chirurgie. Trois patientes ont repris leur traitement de warfarine à une dose plus faible qu'avant l'intervention, puis augmenté celle-ci graduellement; elles n'ont connu aucune complication hémorragique. Aucune patiente n'a eu de thromboembolie veineuse. Une patiente est décédée d'un choc septique.


      Les patientes sous anticoagothérapie à long terme ont tendance à présenter un risque plus élevé de complications hémorragiques après une chirurgie gynécologique majeure qu'après une chirurgie mineure. Nous croyons qu'attendre avant de reprendre le traitement de warfarine et commencer avec une dose plus faible qu'avant l'intervention pourrait réduire le risque de saignements postopératoires, sans augmenter le risque de thromboembolie veineuse.

      Key Words

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