warfarin and Colonic-Pseudo-Obstruction

Patients undergoing joint replacement who show signs of ileus in the postoperative period that require insertion of a nasogastric tube (NGT) must be monitored closely to avoid bleeding complications. The diagnosis of postoperative ileus was documented in 40 of 2,526 (1.6%) consecutive joint replacement operations between January 1, 1990, and March 1, 1998, at 1 hospital. Of the 40 patients with postoperative ileus, 34 received warfarin postoperatively. Of these 34 patients, 19 required a NGT for >48 hours, and 15 patients required a NGT for <48 hours or did not require a NGT. Of the 19 patients who required a NGT for >48 hours and who received warfarin anticoagulation, 17 had a prothrombin time of >20 seconds or an international normalized ratio (INR) of >2.0. None of the 15 patients who required a NGT for <48 hours and who received warfarin anticoagulation had a prothrombin time of >20 seconds or an INR of >2.0. This difference was highly statistically significant (P < .001).

Topics: Anticoagulants; Arthroplasty, Replacement; Colonic Pseudo-Obstruction; Humans; Intubation, Gastrointestinal; Postoperative Care; Postoperative Complications; Prevalence; Thromboembolism; Warfarin