Perioperative management of anticoagulated patients before ENT surgery using the example of panendoscopy

Introduction:

Due to the increasing incidence of cardiovascular diseases, the number of ENT patients with oral anticoagulants (OAC) is increasing. The management of OAK is difficult, especially due to the lack of data for ENT surgery and the need to consult the indication-based disciplines. For this reason, we wondered if there is any difference between patients with and without OAK receiving panendoscopy.

Methods:

We examined all of our clinic's panendoscopies between 10/2016 – 10/2017 and evaluated them for OAC, perioperative OAC-management, blood values and postoperative complications.

Results:

A total of 264 patients received a panendoscopy (Ø 60 years). 24% (63 patients) took OAC or platelet aggregation inhibitors (TAH). The largest share was ASS with 73%, followed by Marcumar with 9.5%. 8% of patients took ASS in combination with another OAC. In 44 patients (70%) with OAC the medication was discontinued. In 19 (30%) of the anticoagulated patients, the medication was not discontinued preoperatively; none of these patients had a bleeding complication. In 2 out of 264 patients, coagulation-related complications (intestinal ischaemia and intraoperative cerebral insult) occurred. In the two patients, the OACs were discontinued preoperatively. These would speak for a settling-specific complication rate of 4.5%.

Discussion:

For small interventions with a low risk of bleeding, after weighing individual risks and especially in patients with OAC or TAH for primary prevention, a perioperative discontinuation of the medication could be dispensed with.

Publication History

Publication Date:
18 April 2018 (online)