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Volume 4 Issue 4 (July - August, 2016)

Original Articles

RETROSPECTIVE ANALYSIS OF PATIENTS ON WARFARIN THERAPY UNDERGOING SURGICAL PROCEDURES- AN INSTITUTION BASED STUDY
Atul Ambole, Manish Kumar, Prashant Jadhav, Nilima Kadam, Gayithri Harish Kulkarni, Harish Shriniwas Kulkarni

Background: warfarin is one of the frequent causes of negative reactions associated with patients undergoing surgical procedures. It is the drug of choice for most of the surgeons despite its adverse effects. Challenges imposed during the management of warfarin reactions include its narrow therapeutic index, frequent drug drug interactions, and patient variability in metabolism of warfarin. Thus, we conducted this retrospective analysis to assess the complications and prognosis of general surgical procedures carried out on patients receiving warfarin therapy. Materials & Methods: A total of 122 patients who underwent surgery in the Surgery department from June 2002 to July 2012 were included in the present study. Complete records and data of all the patients along with pathologic and diagnostic reports were thoroughly analyzed. Surgeries that lasted more than 45 minutes or involved cardiothoracic or orthopaedics field were included under the category of major surgeries. All the results were analyzed by SPSS software. Chi-square test was used to evaluate the level of significance. P-value of less than 0.05 was taken as significant. Results: Mean age of the patients in the present study was 56 years. Comorbidities were present in 64 % of the cases. Various warfarin indications mainly included mitral valve replacement, aortic valve replacement and atrial fibrillation. Pre-operative INR, aPTT and PT values were 1.4, 39 and 17 respectively. Elective surgeries included Hepatobiliary pancreatic surgery, hernia, thyroid and parathyroid surgeries, proctological surgery and colorectal surgery while Emergency surgery included Upper gastrointestinal system, colorectal surgery, hernia and Hepatobiliary pancreatic surgery. While comparing all the parameters between patients undergoing elective and emergency surgeries, only duration of the procedure and length of stay in hospital showed non-significant difference while all other variables showed significant difference. Conclusion: Patients on oral anticoagulant therapy are always at risk levels while undergoing invasive surgical procedures.
Key words: Surgery, Warfarin

 
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