Clinical Application Of Bridge Therapy In Perioperative Gynecologic Surgery

BackgroundTraditional medicine has been opened on many areas along with the progress of modern science and technology, which had been forbidden to use before. Conventional anticoagulant therapy before gynecologic surgery is no longer restricted, Gynecological surgeon also face a growing number of patients treated with oral anticoagulants. The literature shows that the application of normal menstruation women before anticoagulants, the menstrual period and menstrual volume does not changed by taking anticoagulant interference. But with the influence of gynecological diseases, the use of anticoagulation can cause classics blood overmuch, menses is lengthened, and finally it leads to Anemia, blood coagulation function changes. Because of the specific disease and the surgical methods of gynecological, if oral anticoagulants in patients need a gynecological surgery, doctors not only have to balance individual risk for thromboembolism and bleeding, but also consider the gynecological disease and the way of surgery. Therefore, how to use anticoagulation and to select proper timing is the key to successful. The current study found that Low-molecular-weight heparin (LMWH) as the bridge of anticoagulant therapy in perioperation has been accepted by most of scholars, and the periprocedural bridging therapy can be used in patients receiving chronic oral anticoagulation therapy. However, the perioperative management of gynecological patients is still lack of relevant reports. Therefore, it is an important and clinical significance in preoperative evaluation and perioperative management in gynecological surgery.ObjectiveIn this study, we will detect the patient's perioperative indicators of coagulation and fibrinolysis, who is taking oral anticoagulants having a gynecological surgery soon, observe the perioperative blood coagulation and fibrinolysis changes of patients, explore perioperative management in gynecological surgery, assess safety and efficacy of bridging therapy, that Low- molecular- weight heparin (LMWH) as the bridge of anticoagulant therapy in perioperation.MethodsWe select 50 patients with gynecological surgery as the control group, which come from the first affiliated hospital of Zhengzhou university and are all normal female. We select 51 patients from September 2009 to October 2010 as the study group, which will be done a gynecological surgery and need to suspend the oral anticoagulants. We group them of non- malignant and malignant tumor groups, the non- malignant tumor group has 39 patients, while the other one has 12 patients. The patient have 2.5～5.0 mg pre day or clopidogrel 50～100mg per day without thromboembolism formation signs and no bleeding tendency. They are the right one to use the suitable doses. We respectively collect the control group patient blood in preoperative and postoperative 24 hours, three days, five days,7 days to detect prothrombin time (PT) and international normalized ratio (INR). And we respectively collect the study group patients blood in admission and preoperative postoperative 24 hours, three days, five days,7 days to detect prothrombin time (PT) and international normalized ratio (INR). The elective surgery patients who is taking anticoagulants stop their drugs after admission, giving 5000iu Low- molecular-weight heparin (LMWH) by subcutaneous every 12 hours once, which continuous 5-7 days when PT, INR are normal,then stop Low- molecular- weight heparin (LMWH) in preoperative 12 hours. The Emergency surgery use vitamin K120 mg in preoperative 2～4 h, and take the operation after PT,INR normal. We can use 5000iu Low- molecular- weight heparin (LMWH) at Post-operative day 1 (post-operative after 24 hours),and begin to use oral anticoagulants. At Post-operative day 2, Low-molecular- weight heparin (LMWH) can be use in full dose. At Postoperative day 5, Low- molecular- weight heparin (LMWH) can be stop when INR is 2.5. Statistical methods:All of the analyses was completed by statistical software package type SPSS 17.0, and data were expressed as the mean value±SD. In the group, the data compared use self matching material t-test, and comparison between groups use the LSD- t-test (the smallest meaningful difference t test).Result(1).Intraclass comparison:In the control group, PT,INR increased postoperative 24 hours, which have statistically significant comparative differences (P< 0.05), but after 3 days it fell to normal range. In the non-malignant tumor group, PT,INR increased postoperative 24 hours, which have statistically significant comparative differences (P< 0.05), but it rise to admission level at postoperative day 5, which compared with admission difference was not statistically significant. In the malignant tumor group, PT,INR increased postoperative 24 hours and 3 days, which have no statistically significant comparative differences (P<0.05), but it rise to admission level at postoperative day 7 progressively, which compared with admission difference was not statistically significant. Comparison between groups:At postoperative 25 hours and 3 days, in addition to the control group and the non-malignant tumor group, the other groups have statistically significant comparative differences (P<0.05). In other time points, three comparison groups have no statistically significant comparative differences (P<0.05);(2).5 researchers patients appear peri-operative bleeding, who have hemostatic by blood transfusion at intra-operation or postoperation. Two patients appear lower limb vein thrombus, who cured by thrombolysis and anticoagulants. All patients did not happen complications, such as gastrointestinal bleeding, abdominal bleeding, vaginal bleeding complications and wound bleeding. All wound has a good heal. We give all patients Physical examination and ultrasound scan, and all did not discover thrombosis after post- operation 3 month.Conclusion(1). It is very necessary for gynecological patients who are taking oral anticoagulants to monitor the laboratory clotting system index in perioperation.(2).Treatment of patients with malignant tumors should be a bridge program.If there is no other high risk factors of thrombosis,it may be possible to have a suspension of anticoagulation.(3). Low-molecular-weight heparin (LMWH) as the bridge of anticoagulant therapy play an important role in perioperative for gynecological patients who are taking oral anticoagulants.It is safely for gynecological surgery who are taking oral anticoagulants.