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Difficult Decisions in Thoracic Surgery pp 109–124Cite as

Management of Perioperative Anticoagulation in Lung Resection

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY,volume 1))

Abstract

The perioperative management of anticoagulation in patients undergoing pulmonary resection encompasses multiple topics, inherent in each being the balance between the risks of surgical bleeding versus the risks of thrombosis. To address this topic, we evaluated the available literature for recommendations regarding (1) the use of anticoagulation for venous thromboembolism (VTE) prophylaxis(2), the management of patients on chronic anticoagulation (history of pulmonary embolism, chronic atrial fibrillation, mechanical heart valve, etc.), and (3) the management of patients on acute or chronic antiplatelet therapy (cardiac stents, peripheral vascular stents, etc.). We summarize the available data and provide recommendations on how to contend with each of these scenarios in patients undergoing pulmonary resection.

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References

  1. Kalweit G, Huwer H, Volkmer I, Petzold T, Gams E. Pulmonary embolism: a frequent cause of acute fatality after lung resection. Eur J Cardiothorac Surg. 1996;10(4):242–6. discussion 6–7.

    Article  CAS  PubMed  Google Scholar 

  2. Mason DP, Quader MA, Blackstone EH, Rajeswaran J, DeCamp MM, Murthy SC, et al. Thromboembolism after pneumonectomy for malignancy: an independent marker of poor outcome. J Thorac Cardiovasc Surg. 2006;131(3):711–8.

    Article  PubMed  Google Scholar 

  3. Sugarbaker DJ, Jaklitsch MT, Bueno R, Richards W, Lukanich J, Mentzer SJ, et al. Prevention, early detection, and management of complications after 328 consecutive extrapleural pneumonectomies. J Thorac Cardiovasc Surg. 2004;128(1):138–46.

    Article  PubMed  Google Scholar 

  4. Cade JF, Clegg EA, Westlake GW. Prophylaxis of venous thrombosis after major thoracic surgery. Aust N Z J Surg. 1983;53(4):301–4.

    Article  CAS  PubMed  Google Scholar 

  5. Azorin JF, Regnard JF, Dahan M, Pansart M. Efficacy and tolerability of fraxiparine in the prevention of thromboembolic complications in oncologic thoracic surgery. Annales de Cardiologie et d’Angeiologie. 1997;46(5–6):341–7.

    CAS  PubMed  Google Scholar 

  6. Dentali F, Malato A, Ageno W, Imperatori A, Cajozzo M, Rotolo N, et al. Incidence of venous thromboembolism in patients undergoing thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 2008;135(3):705–6.

    Article  PubMed  Google Scholar 

  7. Egawa N, Hiromatsu S, Shintani Y, Kanaya K, Fukunaga S, Aoyagi S. Prevention of venous thromboembolism in thoracic and cardiovascular surgery. Asian Cardiovasc Thorac Ann. 2009;17(5):505–9.

    Article  PubMed  Google Scholar 

  8. Girard P, Demaria J, Lillo-Le Louet A, Caliandro R, Le Guillou JL, Crespin M, et al. Transfusions, major bleeding, and prevention of venous thromboembolism with enoxaparin or fondaparinux in thoracic surgery. Thromb Haemost. 2011;106(6):1109–16.

    Article  CAS  PubMed  Google Scholar 

  9. Bille A, Okiror L, Karenovics W, Pilling J, Lang-Lazdunski L. What is the optimum strategy for thromboembolic prophylaxis following extrapleural pneumonectomy in patients with malignant pleural mesothelioma? Interact Cardiovasc Thorac Surg. 2012;15(2):201–3.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Gomez-Hernandez MT, Rodriguez-Perez M, Novoa-Valentin N, Jimenez-Lopez M, Aranda-Alcaide JL, Varela-Simo G. Prevalence of venous thromboembolism in elective thoracic surgery. Arch Bronconeumol. 2013;49(7):297–302.

    Article  PubMed  Google Scholar 

  11. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e227S–77.

    CAS  PubMed Central  PubMed  Google Scholar 

  12. Gage B, Waterman A, Shannon W. Validation of clinical classification schemes for predicting stroke results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.

    Article  CAS  PubMed  Google Scholar 

  13. Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e326S–50. [Erratum appears in Chest. 2012 ;141(4):1129].

    CAS  PubMed Central  PubMed  Google Scholar 

  14. Chan PS, Patel MR, Klein LW, Krone RJ, Dehmer GJ, Kennedy K, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011;306(1):53–61.

    Article  CAS  PubMed  Google Scholar 

  15. Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery–a prospective outcome study. Br J Anaesth. 2006;96(6):686–93.

    Article  CAS  PubMed  Google Scholar 

  16. Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000;35(5):1288–94.

    Article  CAS  PubMed  Google Scholar 

  17. Schouten O, van Domburg RT, Bax JJ, de Jaegere PJ, Dunkelgrun M, Feringa HH, et al. Noncardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events. J Am Coll Cardiol. 2007;49(1):122–4.

    Article  PubMed  Google Scholar 

  18. Jeremias A, Sylvia B, Bridges J, Kirtane AJ, Bigelow B, Pinto DS, et al. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation. 2004;109(16):1930–2.

    Article  PubMed  Google Scholar 

  19. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126–30.

    Article  CAS  PubMed  Google Scholar 

  20. Brichon PY, Boitet P, Dujon A, Mouroux J, Peillon C, Riquet M, et al. Perioperative in-stent thrombosis after lung resection performed within 3 months of coronary stenting. Eur J Cardiothorac Surg. 2006;30(5):793–6.

    Article  PubMed  Google Scholar 

  21. Cerfolio RJ, Minnich DJ, Bryant AS. General thoracic surgery is safe in patients taking clopidogrel (Plavix). J Thorac Cardiovasc Surg. 2010;140(5):970–6.

    Article  PubMed  Google Scholar 

  22. Ceppa DP, Welsby IJ, Wang TY, Onaitis MW, Tong BC, Harpole DH, et al. Perioperative management of patients on clopidogrel (Plavix) undergoing major lung resection. Ann Thorac Surg. 2011;92(6):1971–6.

    Article  PubMed  Google Scholar 

  23. Paul S, Stock C, Chiu YL, Kansler A, Port JL, Lee PC, et al. Management and outcomes of patients on preoperative plavix (clopidogrel) undergoing general thoracic surgery. Thorac Cardiovasc Surg. 2013;61(6):489–95.

    PubMed  Google Scholar 

  24. Fernandez FG, Crabtree TD, Liu J, Meyers BF. Incremental risk of prior coronary arterial stents for pulmonary resection. Ann Thorac Surg. 2013;95(4):1212–8. discussion 9–20.

    Article  PubMed  Google Scholar 

  25. Savonitto S, D’Urbano M, Caracciolo M, Barlocco F, Mariani G, Nichelatti M, et al. Urgent surgery in patients with a recently implanted coronary drug-eluting stent: a phase II study of ‘bridging’ antiplatelet therapy with tirofiban during temporary withdrawal of clopidogrel. Br J Anaesth. 2010;104(3):285–91.

    Article  CAS  PubMed  Google Scholar 

  26. Broad L, Lee T, Conroy M, Bolsin S, Orford N, Black A, et al. Successful management of patients with a drug-eluting coronary stent presenting for elective, non-cardiac surgery. Br J Anaesth. 2007;98(1):19–22.

    Article  CAS  PubMed  Google Scholar 

  27. D’Urbano M, Barlocco F, Poli A, Fetiveau R, Vandoni P, Savonitto S, et al. Unplanned surgery after drug eluting stent implantation: a strategy for safe temporary withdrawal of dual oral antiplatelet therapy. J Cardiovasc Med. 2008;9:737–41.

    Article  Google Scholar 

  28. Rassi AN, Blackstone E, Militello MA, Theodos G, Cavender MA, Sun Z, et al. Safety of “bridging” with eptifibatide for patients with coronary stents before cardiac and non-cardiac surgery. Am J Cardiol. 2012;110(4):485–90.

    Article  CAS  PubMed  Google Scholar 

  29. Ben Morrison T, Horst BM, Brown MJ, Bell MR, Daniels PR. Bridging with glycoprotein IIb/IIIa inhibitors for periprocedural management of antiplatelet therapy in patients with drug eluting stents. Catheter Cardiovasc Interv. 2012;79(4):575–82.

    Article  CAS  PubMed  Google Scholar 

  30. Bigalke B, Seizer P, Geisler T, Lindemann S, Gawaz M, May AE. Perioperative antiplatelet therapy in patients at risk for coronary stent thrombosis undergoing noncardiac surgery. Clin Res Cardiol . 2009;98(5):335–9.

    Article  PubMed  Google Scholar 

  31. Angiolillo DJ, Firstenberg MS, Price MJ, Tummala PE, Hutyra M, Welsby IJ, et al. Bridging antiplatelet therapy with cangrelor in patients undergoing cardiac surgery a randomized controlled trial. JAMA . 2012;307(3):265–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive EH 215, Indianapolis, IN, 46220, USA

    Jacob R. Moremen MD & DuyKhanh P. Mimi Ceppa MD

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  1. Jacob R. Moremen MD
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  2. DuyKhanh P. Mimi Ceppa MD
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Editors and Affiliations

  1. Surgery, University of Chicago, Chicago, Illinois, USA

    Mark K. Ferguson

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Moremen, J.R., Ceppa, D.P.M. (2014). Management of Perioperative Anticoagulation in Lung Resection. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach, vol 1. Springer, London. https://doi.org/10.1007/978-1-4471-6404-3_9

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  • DOI: https://doi.org/10.1007/978-1-4471-6404-3_9

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6403-6

  • Online ISBN: 978-1-4471-6404-3

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