Assessment of Ten Patients Who were Switched from Antithrombotics to Heparin Sodium before Undergoing Oral and Maxillofacial Surgery

Abstract

  In Japan’s super-aging society, it is becoming increasingly necessary to treat patients with cardiovascular or cerebrovascular disease who are undergoing treatment with anticoagulants and antiplatelets. Generally, guidelines for antithrombotic therapy recommend switching from antithrombotics to heparin sodium during the perioperative period. We studied 10 patients undergoing antithrombotic therapy who were scheduled to undergo oral and maxillofacial surgery. The frequency of bleeding complications was compared between patients receiving antiplatelet drugs alone and those receiving both antiplatelet and anticoagulant drugs during the perioperative period. According to our protocol, antiplatelet drugs and/or warfarin potassium were terminated 4 to 10 days prior to surgery, and heparin sodium was administered intravenously with an infusion pump at a dose of 10,000 units per day. Six hours prior to the operation, the heparin sodium infusion was terminated. Six patients received antiplatelet drugs alone. Heparin sodium was restarted 1 day postoperatively in two patients, but all the patients were switched back to oral antiplatelet therapy. No bleeding complications occurred among the six patients. In another four patients receiving warfarin potassium and antiplatelet drugs, heparin sodium was restarted 1 or 2 days after the operation. Warfarin sodium and antiplatelet drugs were restarted 1 to 7 days after the operation in three of these four patients (all except Patient 10). Otherwise, bleeding complications occurred in all four patients. In Patient 10, postoperative bleeding from the wound area in the soft palate continued for 10 days postoperatively ; this patient suffocated because of a large hemorrhagic mass and cardiopulmonary arrest. This study did not provide enough data to show that bleeding complications may occur when a combination of heparin, warfarin potassium, and antiplatelet drugs is restarted.