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Anticoagulant history linked to 3.4 times higher transfusion risk in lumbar surgery
Researchers saw increased blood loss in patients despite controlling when medication was discontinued.
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SAN FRANCISCO — Prior use of a commonly prescribed anticoagulant increased intraoperative blood loss, length of hospital stay and risk of transfusion in patients undergoing lumbar decompression, according to the results of a recently presented study.
“Despite adequate control of the international normalized ratios and adherence to preoperative protocols, the patients on Coumadin [warfarin sodium, Bristol-Myers Squibb, Princeton, NJ] ended up having increased intraoperative blood loss, increased length of stay [and] increased risk of receiving some form of transfusion,” study investigator Ernest Young, MS, said during his presentation at the American Academy of Orthopedic Surgeons 2012 Annual Meeting.
Young and colleagues conducted a retrospective chart review of 256 patients who underwent lumbar surgery between 2005 and 2007, and compared the outcomes of patients without a history of anticoagulants to those who took the anticoagulant prior to surgery. Patients in the anticoagulation group had an international normalized ratio of 1.1 and stopped taking the medication 5 days to 7 days prior to surgery.
Patients in the study had a mean age of 58 years and a mean body mass index of 29. Overall, 29% of the patients in the study were in the anticoagulation group and 19% of all patients underwent transfusions.
After correcting for confounding variables such as comorbidities, age, gender, body mass index and magnitude of surgery, investigators found that patients in the anticoagulation group lost 800 ml of blood compared to 400 ml in the control group. Patients in the anticoagulation group showed a 3.4 times greater risk for requiring a transfusion, with investigators noting that 42% of patients in that cohort required transfusion. In addition, they discovered a longer average length of hospital stay for anticoagulation group (4.6 days vs. 3.3 days).
Young stressed the importance of counseling patients on the anticoagulant about the increased length of hospital stay and the possibility of transfusion in the operating room or during recovery.
“The study tells us that [the] international normalized ratio is not a perfect measure of the patient’s propensity to bleed,” Young said. “[The] International inormalized ratio does not reflect the rebalancing of the patient’s clotting. We need to increase the time off coumadin to somehow tweak the preoperative protocol, and we need to still manage that and balance it with the thromboembolic risk.” – by Renee Blisard Buddle
Reference:
- Young E, Ahmadinia K, Ahn NU. Coumadin is associated with increased blood loss and transfusion in lumbar surgery despite preoperative correction. Paper #288. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
- Ernest Young, MS, can be reached at the Department of Orthopedics, Case Western Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH 44106; email: exy50@case.edu.
- Disclosure: Young has no relevant financial disclosures.