The association of excessive warfarin anticoagulation and postoperative ileus after total joint replacement surgery

Patients undergoing joint replacement who show signs uf ileus in the postop erative period that require insertion of a nasogastric tube (NGT) must be m onitored closely to avoid bleeding complications. The diagnosis of postoper ative ileus was documented in 40 of 2,526 (1.6%) consecutive joint replacem ent operations between January 1, 1990, and March 1, 1098, at 1 hospital. O f the 40 patients with postoperarive ileus. 34 received warfarin postoperat ively. Of these 34 patients, 19 required a NGT for >48 hours, and 15 patien ts required a NGT for <48 hours or did nor require a nTGT. Of the 19 patien ts who required a NGT for >48 hours and who received warfarin anticoagulati on, 17 had a prothrombin time of >20 seconds or an international normalized ratio (INR) of >2.0. None of the 15 patients who required a NGT for <48 ho urs and who received warfarin anticoagulation had a prothrombin time of >20 seconds or an INR of >2.0. This difference was highly statistically signif icant (P < .001).