439 A review of the management of Anti-coagulation and anti-platelet medication in surgical patients in a University Hospital

Management of surgical patients on anti-coagulation and anti-platelet medication can be challenging. Balance between discontinuation, with thrombotic risk, and continuation or early re-initiation with risk of bleeding should be considered. In emergency setting patients are managed depending on clinical situation.

Aim

To review the management of anticoagulant or antiplatelet therapy in acute and elective surgical patients.

Methods

Method: Electronic data was retrospectively reviewed for both elective and emergency admissions to surgical ward during two weeks period. Data including age, sex, admission diagnosis, indication and nature of anti-thrombotic or antiplatelet medication, and thromboembolic or bleeding complications were collected.

Results

30 patients (19 male, 11 female) with a mean age of 74 (54-90) were reviewed. 22 patients were emergency admission and 8 were elective.

All elective cases had their medication withheld. Three patients developed complications including 1 rectal bleeding, 1 post liver biopsy bleed and 1 internal jugular vein thrombosis.

17 emergency patients had their medication withheld. 5 patients underwent surgery and 7 patients had endoscopic invasive procedures (ERCP). One patient developed bowel ischemia from arterial thrombosis following emergency open cholecystectomy. Among the 5 patients who continued the medication one patient had ERCP and others did not receive any intervention.

Conclusion

Patients on anti-coagulation and anti-platelet medication undergoing invasive procedure can develop thrombo-embolic or bleeding complication.