Abstract
Objective
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.
Results
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.
Conclusion
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.
Résumé
Objectif
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.
Résultats
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.
Conclusion
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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Article info
Publication history
Published online: August 15, 2017
Accepted:
May 31,
2017
Received:
April 17,
2017
Footnotes
Competing interests: None declared.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
