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. 2018 Nov 9;3(1):85-88.
doi: 10.1002/rth2.12159. eCollection 2019 Jan.

The effect of stopping phenprocoumon 5 days preoperatively: A retrospective study

Silke Knol  1 , Mascha Mallo  2 , Reinier Tromp Meesters  2 , Jan Westerink  3 , Marcel van de Ree  1
Affiliations

The effect of stopping phenprocoumon 5 days preoperatively: A retrospective study

Silke Knol et al. Res Pract Thromb Haemost. .

Abstract

Background: Clinicians lack substantiated guidance on when vitamin K antagonist (VKA) treatment should be interrupted preoperatively, especially with regard to phenprocoumon, with its long half-life of 5.5 days.

Objective: To evaluate the efficacy of discontinuing phenprocoumon 5 days preoperatively and determine whether a safe international normalized ratio (INR) was reached.

Methods: This was a retrospective review of 118 patients using phenprocoumon prior to elective surgery. Preoperative INRs and factors that could potentially influence these values were identified and described. A safe preoperative INR was defined as <1.8.

Results: Of the 118 included patients, 42 patients (35.6%) had an off-target INR. The male sex was significantly and independently associated with an off-target INR (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.022-5.445). A high American Society of Anesthesiologists (ASA) classification was also significantly and independently associated with an off-target INR (OR 2.3, 95% CI: 1.029-5.173).

Conclusion: Discontinuation of phenprocoumon 5 days preoperatively resulted in an INR < 1.8 in more than one-third of patients. Individualizing or extending the period of phenprocoumon discontinuation may be a necessary treatment option.

Keywords: anticoagulant; international normalized ratio; phenprocoumon; preoperative care; vitamin k antagonists.

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