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Was wondering if anyone could clear up this issue I'm battling to get to grips with. What is the correct approach to periop anticoagulation in the patient less than 1 month post arterial (lets say cerebral) thromboembolism.
My sources say that risk of postop bleed with early postoperative heparin is 11%, and risk of further thromboembolism is 40-50% in the non-anticoagulated patient. The problem is that they also suggest that the risk of death from postop bleeding is 3%.
They recommend that postoperative heparin be withheld in all but the most minor surgery (i.e. the surgery with the lowest risk of bleeding). What about the others. Surely a 3% risk of dying from an 11% risk postop bleed is lower risk than arterial thromboembolism to the brain where risk of total dependency is probably around 40%?
Can anyone unpack this/clarify the issue. Not sure if how I've explained the issue makes sense...Thanks
My sources say that risk of postop bleed with early postoperative heparin is 11%, and risk of further thromboembolism is 40-50% in the non-anticoagulated patient. The problem is that they also suggest that the risk of death from postop bleeding is 3%.
They recommend that postoperative heparin be withheld in all but the most minor surgery (i.e. the surgery with the lowest risk of bleeding). What about the others. Surely a 3% risk of dying from an 11% risk postop bleed is lower risk than arterial thromboembolism to the brain where risk of total dependency is probably around 40%?
Can anyone unpack this/clarify the issue. Not sure if how I've explained the issue makes sense...Thanks
