Korean J Thorac Cardiovasc Surg.  2016 Oct;49(5):329-336. 10.5090/kjtcs.2016.49.5.329.

A Korean Multi-Center Survey about Warfarin Management before Gastroenterological Endoscopy in Patients with a History of Mechanical Valve Replacement Surgery

• Son KH
• Choi CH
• Lee JI
• Kim KW
• Kim JS
• Lee SY
• Park KY
• Park CH

• KMID: 2354365
• DOI: http://doi.org/10.5090/kjtcs.2016.49.5.329

Abstract

BACKGROUND
Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases.
METHODS
The questionnaire was administered to cardiac surgeons and consisted of eight questions, including two case scenarios.
RESULTS
Thirty-six cardiac surgeons at 28 hospitals participated in the survey, and 52.7% of the participants chose to stop warfarin before EGD in aortic valve replacement patients without risk factors for thromboembolism. When the patient's INR level was 2, 31% of the participants indicated that they would choose to continue warfarin therapy. For EGD with biopsy, 72.2% of the participants chose warfarin withdrawal, and 25% of the participants chose heparin replacement. In mitral valve replacement patients, 47.2% of the participants chose to discontinue warfarin, and 22.2% of the participants chose heparin replacement. For EGD with biopsy in patients with a mitral valve replacement, 58.3% of the participants chose to stop warfarin, and 41.7% of the participants chose heparin replacement.
CONCLUSION
This study demonstrated that attitudes regarding warfarin treatment for EGD are very different among Korean surgeons. Guidelines specific to the Korean population are required.

Keyword

Heart valve prosthesis; Anticoagulants; Endoscopy; Hemorrhage; Thromboembolism

MeSH Terms

Anticoagulants
Aortic Valve
Biopsy
Endoscopy*
Endoscopy, Digestive System
Heart Valve Prosthesis
Hemorrhage
Heparin
Humans
International Normalized Ratio
Korea
Mitral Valve
Risk Factors
Surgeons
Thromboembolism
Warfarin*
Anticoagulants
Heparin
Warfarin