The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review

Periprocedural vitamin K antagonist management is a complex process and inherently entails multiple clinical issues. Marked variations have been reported in different aspects of this process. These differences were noted at the clinician and institutional levels owing to the lack of evidence-based d...

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Autores principales:	Islam Eljilany MSc, Ahmed El-Bardissy PharmD, Hazem Elewa PhD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/10079a2e68c44cc38f8f18afed5934aa
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spelling	oai:doaj.org-article:10079a2e68c44cc38f8f18afed5934aa2021-12-02T01:33:35ZThe Dilemma of Peri-Procedural Warfarin Management: A Narrative Review1938-272310.1177/10760296211012093https://doaj.org/article/10079a2e68c44cc38f8f18afed5934aa2021-11-01T00:00:00Zhttps://doi.org/10.1177/10760296211012093https://doaj.org/toc/1938-2723Periprocedural vitamin K antagonist management is a complex process and inherently entails multiple clinical issues. Marked variations have been reported in different aspects of this process. These differences were noted at the clinician and institutional levels owing to the lack of evidence-based data leading to many discrepancies in decision-making. This review aims to address the gap of vitamin K antagonist periprocedural management acknowledged by previously published prescribers’ questionnaires. One of the components of this process is “bridging,” which aims to provide minimal interruption of the anticoagulation period through the use of heparin products. Recent studies showed that bridging is increasing bleeding risk. Secondly, interruption decision relies on the classification of thromboembolism risk which depends on trials that did not include patients with atrial fibrillation. Thirdly, the interruption duration is different among different International normalization ratio levels, which strengthens the difference in the clinical practice of preoperative vitamin K antagonist management. Lastly, the resumption of a vitamin-K antagonist after surgery has many scenarios according to the procedure and patient risk of bleeding. Vitamin-K antagonist periprocedural management is complicated due to individual practice and the lack of strictly implemented institutional standardized protocols to guide, manage and evaluate the process.Islam Eljilany MScAhmed El-Bardissy PharmDHazem Elewa PhDSAGE PublishingarticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENClinical and Applied Thrombosis/Hemostasis, Vol 27 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Islam Eljilany MSc Ahmed El-Bardissy PharmD Hazem Elewa PhD The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
description	Periprocedural vitamin K antagonist management is a complex process and inherently entails multiple clinical issues. Marked variations have been reported in different aspects of this process. These differences were noted at the clinician and institutional levels owing to the lack of evidence-based data leading to many discrepancies in decision-making. This review aims to address the gap of vitamin K antagonist periprocedural management acknowledged by previously published prescribers’ questionnaires. One of the components of this process is “bridging,” which aims to provide minimal interruption of the anticoagulation period through the use of heparin products. Recent studies showed that bridging is increasing bleeding risk. Secondly, interruption decision relies on the classification of thromboembolism risk which depends on trials that did not include patients with atrial fibrillation. Thirdly, the interruption duration is different among different International normalization ratio levels, which strengthens the difference in the clinical practice of preoperative vitamin K antagonist management. Lastly, the resumption of a vitamin-K antagonist after surgery has many scenarios according to the procedure and patient risk of bleeding. Vitamin-K antagonist periprocedural management is complicated due to individual practice and the lack of strictly implemented institutional standardized protocols to guide, manage and evaluate the process.
format	article
author	Islam Eljilany MSc Ahmed El-Bardissy PharmD Hazem Elewa PhD
author_facet	Islam Eljilany MSc Ahmed El-Bardissy PharmD Hazem Elewa PhD
author_sort	Islam Eljilany MSc
title	The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
title_short	The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
title_full	The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
title_fullStr	The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
title_full_unstemmed	The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review
title_sort	dilemma of peri-procedural warfarin management: a narrative review
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/10079a2e68c44cc38f8f18afed5934aa
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The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review

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