Patients with oral anticoagulation

J. Koscielny; S. Ziemer; von C. Heymann

doi:10.1055/s-0037-1617035

Hämostaseologie, Table of Contents

Hamostaseologie 2009; 29(03): 247-255
DOI: 10.1055/s-0037-1617035

Original article

Schattauer GmbH

Patients with oral anticoagulation

Bridging anticoagulation in the perioperative phasePatienten unter oraler AntikoagulationPerioperatives Bridging

J. Koscielny

¹Institut für Transfusionmedizin, Charité, Universitätsmedizin Berlin

,

S. Ziemer

²Institut für Laboratoriumsmedzin und Pathobiochemie, Charité, Universitätsmedizin Berlin

,

von C. Heymann

³Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Virchow-Klinikum und Campus Charité Mitte, Universitätsmedizin Berlin

› Author Affiliations

Abstract

Summary

Oral anticoagulation with a vitamin K-antagonist requires special consideration when surgery or interventional procedures are planned. This is mainly due to the half life of vitamin K-antagonists and to the need for safe and effective anticoagulation prior to and during surgery as well as in the postoperative period. So far, the continuous infusion of unfractionated heparin (UFH) has been the medication of choice to ,,bridge“ patients to surgery.

The use of low molecular weight heparins (LMWH) has been prospectively investigated in this setting and represents a safe alternative. The advantages of LMWH are the better dose-response relationship and reduced need for monitoring. This facilitates the bridging procedure to be started out of hospital, which may reduce hospital stay and associated costs. Furthermore, the so-called bridging of patients with oral anticoagulation prior to and during surgery reduces bleeding complications and maintains a safe anticoagulation for patients at risk.

Zusammenfassung

Die subkutane Applikation von niedermolekularem Heparin (NMH) in therapeutischer oder halbtherapeutischer Dosierung stellt eine sichere und wirksame Alternative zur kontinuierlichen intravenösen Infusion von unfraktioniertem Heparin (UFH) bei Unterbrechung der Gabe von Vitamin-K-Antagonisten vor Opera-tionen oder Interventionen dar.

Die entscheidenden Vorteile von NMH gegenüber der Gabe von UFH bestehen in der besseren Dosis-Wirkungsbeziehung und dem reduzierten labortechnischen Monitoring. Dies ist eine Voraussetzung für den ambulanten Beginn. Dadurch können sich Krankenhausverweildauer und Kosten reduzieren. Darüber hinaus reduziert das so genannte Bridging von Patienten mit oraler Antikoagulation das Blutungsrisiko vor und während Operationen und gewährleistet trotzdem eine sichere Anti-koagulation bei Risikopatienten.

Keywords

Oral anticoagulation - vitamin K-antagonist - perioperative bridging - unfractionated heparin - low molecular weight heparin

Schlüsselwörter

Orale Antikoagulation - Vitamin-K-Antagonisten - perioperatives Bridging - unfraktioniertes Heparin - niedermolekulares Heparin

Full Text

References

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