Summary

Objective: Routine surgery on varicose veins in patients receiving permanent oral anticoagulation (OAC) is always problematic. Therefore, we assessed the risk for perioperative bleeding and the rate of haemorrhagic complications in these patients. Patients, methods: The study was conducted on patients with OAC undergoing intervention on varicose veins in the years 2002 to 2006. In order to define haemorrhagic complications (HC) the following criteria were applied: postoperative anaemia: Hb-value in men <12.5 g/dl, in women <11.5 g/dl, haematoma requiring evacuation, significant haematoma or haemorrhage infiltrations requiring treatment for >4 weeks. Patients were allocated to 4 groups: 1: patients ≤65 years; 2: patients >65 years; HC: patients with HC; WHC: patients without HC. Results: The study was conducted on 131 patients with OAC (1.42%): 75 men, 56 women. Group 1: 54 patients (41.2%) of which 14 (25.9%) suffered HC, group 2: 77 patients (58.8%) of which 29 (37.7%) suffered HC. Group HC: 43 patients (32.8%): 14 men, 29 women, group WHC: 88 patients (67.2%): 61 men, 27 women. Mean age group HC: 69.5 ± 6.7 years, mean age group WHC: 64.5 ± 9.8 years (p=0.005). Diagnosed HC: Significant haematoma or infiltrations (19.9%), haematoma requiring evacuation (5.3%), only anaemia (7.6%). All patients demonstrated a significant difference in pre- and postoperative Hb-value (p=0.001), the most significant difference occurred comparing group HC with group WHC (14.0 ± 1.3 g/dl → 11.7 ± 2.2 g/dl vs. 14.3 ± 1.1 g/dl → 13.6 ± 1.2 g/dl). Conclusion: In routine surgery on varicose veins patients with OAC are at an increased risk of perioperative HC. HC appeared more often in patients older than 65 and twice as often in women and in patients receiving full heparin dose. However, adopting specific surgical procedures and appropriate postoperative management the risk of haemorrhagic complications can be reduced significantly.