Post-operative complications after abdominal surgery in patients treated with oral anticoagulant therapy

Introduction: The management of oral anticoagulant therapy preceding abdominal surgery is a clinical problem that will be more and more frequent in the coming years. Objectives: To investigate the correlation between comorbidities (at the time of surgical treatment) and abdominal surgery post-operative complications in patients treated with OAT, in order to identify risk stratification, correct timing of surgical treatment and postoperative support requirement. Materials and Methods: In this Prospective Observational Study all patients undergoing abdominal programmed surgery between September 1st 2009 and May 31th 2011 were enrolled. Surgical outcomes and complications were recorded (transfusion requirements, anastomotic leaks, abdominal wall collections, abdominal collections, re-interventions, infections, anemia, hospital re-admission, death). Results: A total of 834 patients were therefore considered,35 inOAT (Group A) and 780 not in OAT (Group B). Seven patients in Group A and 153 patients in Group B required transfusion (20,0% vs 19,6%, p= ns), with a mean of 2.71 RBC units required in Group A and2.75 inGroup B. As for fresh frozen plasma, the mean requirement was 0.57 units in Group A as compared to 0.24 units in Group B (p= ns). Conclusions: Although bleeding in the peri-operative period was feared, hemorrhagic events were not more frequent in the OAT group as compared to the non-OAT one. On the contrary, the most serious complications, including death, were related to thrombotic episodes. A multidisciplinary evaluation is therefore fundamental for these patients, requiring the implementation of new "ad hoc" guidelines.