Title: Anaesthetic management of a patient with cortical sinusvenous thrombosis on Warfarin therapy posted for emergency dilatation and curettage
Authors: Kothamasu Sombabu, S. Anand, Adhilakshmi, Lailu Mathews
DOI: https://dx.doi.org/10.18535/jmscr/v8i2.150
Abstract
Hypercoagulability, venous stasis and vascular damage are initiating factors for venous thrombosis. Women in reproductive age group are more prone for central sinus venous thrombosis (CSVT) due to pregnancy, puerperium and use of oral contraceptives. Women previously diagnosed with cortical sinus venous thrombosis will have been on oral anticoagulants like Warfarin to prevent further thromboembolic events. Patients on Warfarin posted for emergency surgery, are at high risk of bleeding and requires preoperative stabilization, in order to prevent perioperative hemorrhage.1 Adequate pre-operative stabilization of a patient on Warfarin undergoing major surgery or minor surgery reduces intraoperative risk of bleeding.
Case Report: 31 year old, lady had presented to labor ward with bleeding per vaginam over the 24 hours. She was a known case of sinus venous thrombosis since 2013, on warfarin therapy for the same since. Urine pregnancy test done was positive, and an ultrasound of the abdomen depicted retained products of conception. It was hence decided that she required dilatation and curettage of the uterus for removal of the same. Pre-operatively, her INR was sent for and was found to be on a higher level from control (2.49),and she was transfused six fresh frozen plasma (FFP) prior to the procedure.
Keywords: Central venous Sinus thrombosis, dilatation and curettage, Warfarin, fresh frozen plasma.
References
- Shaikh SI, Kumari RV, Hegade G, Marutheesh M. Perioperative Considerations and Management of Patients Receiving Anticoagulants. Anesth Essays Res. 2017;11(1):10–16.
- Ellen M. Lockhart, Curtis L. Baysinger; Intracranial Venous Thrombosis in the Parturient. Anesthesiology2007;107(4):652-658.
- Craig Oranmore-Brown, MBBCh FRCA, Richard Griffiths, MD FRCA, Anticoagulants and the perioperative period, Continuing Education in Anaesthesia Critical Care & Pain, 2006; 6(4):156–159.
- Keeling D. Comment on Guidelines on oral anticoagulation with warfarin - 4th edition. Response to Gosai & Muthusamy. British Journal of Haematology. 2011;156(1):151-151.
- Emergency Reversal of Oral Anticoagulation, Anesthesiology 2011;113 (11):1192-1197.