A survey of clinical decision making in arthroscopy patients on Coumadin

摘要

Background: Arthroscopy is one of the most common orthopaedic procedures. Some patients who may benefit from a simple arthroscopic procedure are on anticoagulation for an underlying medical condition. The historical recommendation has been to discontinue Coumadin (Bristol-Myers Squibb Co, Princeton, NJ) before surgery. The risk or benefit of this decision has not been discussed to date for simple arthroscopic procedures in orthopaedics. Methods: Members of the American Orthopaedic Society for Sports Medicine (AOSSM) or Arthroscopy Association of North America (AANA) were surveyed in regard to their clinical decision making for patients on Coumadin undergoing simple arthroscopic procedures. As part of the survey, participants noted any coagulation-related medical or surgical complications that had occurred in their practice. The pooled answers were analyzed for evaluation of current treatment trends and a crude assessment of complication prevalence. Results: More than 30% of the members of the associations responded to the survey (827). Nearly 90% of the respondents reported discontinuing Coumadin before arthroscopic surgery. An increased number of reported medical complications were seen in patients when Coumadin was withheld before the procedure. In patients who remained on Coumadin, surgical complications predominated, all being bleeding or hemalomas. Conclusions: The majority of experienced arthroscopists said they withhold Coumadin during the perioperative period. All of the medical complications were seen in patients who had Coumadin withheld. Surgical complications of bleeding and hematoma formalion were the most commonly reported complications seen in patients who remained on Coumadin. The risk or benefit of withholding Coumadin in these patients should be further analyzed.