Management of surgical complications following prolonged warfarin therapy in a general surgical hospital

Krylov A.Yu.

Sechenov First Moscow State Medical University

Shulutko A.M.

Sechenov First Moscow State Medical University

Khmyrova S.E.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-4455-6716

Petrovskaya A.A.

Sechenov First Moscow State Medical University

Gandybina E.G.

Sechenov First Moscow State Medical University

Gorbacheva A.V.

Sechenov First Moscow State Medical University

Patalova A.R.

Sechenov First Moscow State Medical University

Management of surgical complications following prolonged warfarin therapy in a general surgical hospital

Authors:

Krylov A.Yu., Shulutko A.M., Khmyrova S.E., Petrovskaya A.A., Gandybina E.G., Gorbacheva A.V., Patalova A.R.

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Journal: Pirogov Russian Journal of Surgery. 2021;(9): 54‑62

DOI: 10.17116/hirurgia202109154

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To cite this article:

Krylov AYu, Shulutko AM, Khmyrova SE, Petrovskaya AA, Gandybina EG, Gorbacheva AV, Patalova AR. Management of surgical complications following prolonged warfarin therapy in a general surgical hospital. Pirogov Russian Journal of Surgery. 2021;(9):54‑62. (In Russ.)
https://doi.org/10.17116/hirurgia202109154

Подписка 2025-2 (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital.

MATERIAL AND METHODS

The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients — over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests — thromboelastography (TEG) and thrombodynamics test (TT).

RESULTS

Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications — in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment — 25 patients, after two days — 2 patients). Ten patients underwent endoscopic hemostasis, two patients — ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy.

CONCLUSION

The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.

Keywords:

surgical complications

warfarin

general surgical hospital

Authors:

Krylov A.Yu.

Sechenov First Moscow State Medical University

Shulutko A.M.

Sechenov First Moscow State Medical University

Khmyrova S.E.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-4455-6716

Petrovskaya A.A.

Sechenov First Moscow State Medical University

Gandybina E.G.

Sechenov First Moscow State Medical University

Gorbacheva A.V.

Sechenov First Moscow State Medical University

Patalova A.R.

Sechenov First Moscow State Medical University

Received:

20.02.2021

Accepted:

10.03.2021

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