Peri-procedural Anticoagulation Management of Patients with Thrombophilia.
Am J Med. 2016 May 24;
Authors: Wysokinska EM, Wysokinski WE, Ketha S, Litin S, Daniels P, Slusser J, Hodge DO, Heit JA, McBane RD
PURPOSE: or Background: Appropriate peri-procedural management of the chronically-anticoagulated patient with an inherited or acquired thrombophilia is uncertain. The objective of this study was to test "thrombophilia" as a potential predictor of the 3-month cumulative incidence of thromboembolism and major bleeding among chronically-anticoagulated patients undergoing an invasive procedure.
METHODS: In a prospective cohort study, consecutive chronically-anticoagulated patients referred to the Mayo Thrombophilia Center for standardized peri-procedural anticoagulation management who had venous thromboembolism and complete thrombophilia testing were categorized as "severe", "non-severe", or "no identifiable" thrombophilia. The 3-month cumulative incidence rates of thromboembolism, bleeding and death were estimated using the Kaplan-Meier product limit method.
RESULTS: Among 362 patients with complete thrombophilia testing, 165 (46%) had a defined thrombophilia; 76 patients had severe thrombophilia, mainly due to antiphospholipid syndrome (66%). Half of the patients in each of the 3 groups received pre and post procedure heparin. During follow up, there were no thromboembolic events, rare major bleeding events (1% for each group) and 4 deaths. Due to the very low event rates for each of these outcomes, Cox proportional hazard modeling could not be performed.
CONCLUSIONS: Peri-procedural event rates were low irrespective of thrombophilia status. Inherited or acquired thrombophilia was not a predictor of thromboembolism, major bleeding or mortality after temporary interruption of chronic anticoagulation for an invasive procedure.
PMID: 27235004 [PubMed - as supplied by publisher]