Key result
Perioperative heparin bridging triggers fatal continuous postoperative bleeding and cardiopulmonary arrest after palate resection.
Why the study?
Management of perioperative anticoagulation in patients with prior valve replacement and coronary artery bypass grafting undergoing surgery is complex and requires multidisciplinary collaboration to prevent complications.
Case Report (n=1)
No
Perioperative heparin bridging in patients on long-term antithrombotic therapy undergoing oral surgery can lead to severe postoperative bleeding and life-threatening airway obstruction.
May precipitate severe bleeding and airway obstruction in oral surgery; hypothesis-generating for safer bridging protocols in prospective studies.
An 84-year-old woman underwent soft palate resection and skin grafting with tie-over under general anesthesia. Fourteen years previously, she had undergone aortic valve replacement and coronary artery bypass grafting followed by lifelong warfarin and aspirin anticoagulation. We terminated the two drugs 8 and 6 days, respectively, before the present surgery and substituted intravenous heparin (10,000 units/day), which was terminated 6 h preoperatively. The surgery was uneventful. Heparin was restarted 2 days postoperatively but without warfarin potassium or aspirin because of postoperative soft palate bleeding, which continued for 10 days despite compression hemostasis. On day 10, she exhibited a suffocating large hemorrhagic mass, leading to cardiopulmonary arrest. Emergency consultation with medical doctors and dental anesthetists resulted in pulmonary resuscitation and tracheal intubation. After confirming spontaneous circulation/respiration, she was transferred to the intensive care unit. We now consider it essential that all medical/surgical/anesthesia specialists managing patients under anticoagulant therapy collaborate perioperatively.
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Sato et al. (2021) conducted a case report in Postoperative bleeding and airway obstruction (n=1). Heparin bridging therapy was evaluated on Cardiopulmonary arrest due to airway obstruction from postoperative bleeding. Perioperative heparin bridging in an 84-year-old woman undergoing soft palate resection led to continuous postoperative bleeding, resulting in airway obstruction and cardiopulmonary arrest on postoperative day 10.
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