caa a22 4500 477061621 CHVBK 20180405111402.0 cr unu---uuuuu 170330e19960301xx s 000 0 eng 10.1007/BF01061914 doi (NATIONALLICENCE)springer-10.1007/BF01061914 Workshop: Special problems in anticoagulation therapy: Cancer and venous thromboembolism-temporary discontinuation of warfarin for surgery and invasive procedures [Elektronische Daten] [Sally Loken, Jill Allen, Barry Stults] Health care providers monitoring anticoagulated patients are often asked to make recommendations regarding anticoagulant management during periods when illness or treatment may complicate anticoagulant therapy. Two particularly difficult clinical problems concern the indications for and management of anticoagulant therapy in patients with cancer and the management of anticoagulated patients who must undergo some type of surgical procedure. Cancer is a significant risk factor for a variety of thromboembolic disorders, particularly venous thromboembolism. Venostasis from immobility, vessel wall damage from tumor invasion, and especially tumor-mediated activation of the coagulation system are important contributors to the prethrombotic state in cancer patients. The risk of venous thromboembolism is greatest during surgery, chemotherapy, and long-term use of central venous catheters. For selected patients, prophylaxis with subcutaneous heparin, low-intensity warfarin, or very low-intensity warfarin may substantially reduce this risk. A related concern for primary care clinicians is the increasing evidence that idiopathic venous thromboembolism may be the first manifestation of occult cancer. Whether and how these patients should be screened for malignancy is currently uncertain. Prior to surgical procedures in anticoagulated patients, clinicians must compare the risk of bleeding if anticoagulation is continued with the risk of recurrent thrombosis if anticoagulation is stopped. Bleeding risk is influenced by how a specific procedure affects the ability to assess and control bleeding and the intensity of anticoagulation at the time of the procedure. Thromboembolism risk is determined by the specific indication for the anticoagulation and the length of time during which anticoagulant therapy must be discontinued. Guidelines are suggested for perioperative anticoagulant management of patients with different thromboembolic disorders undergoing a variety of surgical procedures. Kluwer Academic Publishers, 1996 anticoagulation nationallicence cancer nationallicence venous thromboembolism nationallicence warfarin nationallicence Loken Sally Anticoagulation Clinic, Salt Lake City Veterans' Affairs Medical Center, Salt Lake City, UT aut Allen Jill Department of Medicine, University of Utah Medical Center, 50 North Medical Drive, 84132, Salt Lake City, UT aut Stults Barry Department of Medicine, University of Utah Medical Center, 50 North Medical Drive, 84132, Salt Lake City, UT aut Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 2/4(1996-03-01), 289-293 0929-5305 2:4<289 1996 2 11239 https://doi.org/10.1007/BF01061914 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF01061914 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Loken Sally Anticoagulation Clinic, Salt Lake City Veterans' Affairs Medical Center, Salt Lake City, UT aut NATIONALLICENCE 700 1- Allen Jill Department of Medicine, University of Utah Medical Center, 50 North Medical Drive, 84132, Salt Lake City, UT aut NATIONALLICENCE 700 1- Stults Barry Department of Medicine, University of Utah Medical Center, 50 North Medical Drive, 84132, Salt Lake City, UT aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 2/4(1996-03-01), 289-293 0929-5305 2:4<289 1996 2 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer