SURGERY ON PATIENTS UNDER ANTICOAGULATION THERAPY IN EMERGENCY AND ELECTIVE SITUATIONS

Patients under oral anticoagulation with coumarin derivatives have a v ariable perioperative thromboembolic risk which necessitates continuat ion of their thromboembolic prophylaxis during elective and emergency surgery Because of their better handling unfractionated heparin and lo w-molecular-weight heparins are used most often for this purpose. The overlapping effect of coumarin and heparin therapy requires a close da ily monitoring of the clotting inhibition (partial thromboplastin time , thromboplastin time, thrombin time). In elective surgery coumarin th erapy is interrupted 2-3 days preoperatively: in emergency cases vitam in K or fresh frozen plasma have to be substituted, Patients under hep arin therapy or prophylaxis are easier to handle, because the effect o f heparin disappears in a few hours after stopping the treatment. In t he immediate postoperative phase the heparin application is interrupte d for 6 h because of increased bleeding risk, It is important to take into account additional risk factors like the underlying disease, dist urbances of platelet function, liver diseases and renal insufficiency.