Endoscopic Sinus Surgery in Patients Receiving Anticoagulant or Antiplatelet Therapy

Background: Endoscopic Sinus Surgery (ESS) has not been studied in patients receiving anticoagulant or antiplatelet therapy. Classifing this procedure into a bleeding risk category needs to be done to safely manage these therapies perioperatively.

Methods:

Design: Retrospective case control study of prospectively collected data.

Setting: Academic tertiary referral center.

Patients: 42 patients receiving anticoagulant therapy who underwent an endoscopic sinus surgery between October 1997 and December 2005, compared to a control group of 42 patients matched for age and gender.

Results: The mean estimated blood loss (EBL) during surgery was slightly higher for the control group without reaching a statistically significant difference (p = 0.14). EBL was significantly higher when more sinuses were opened during surgery (p = 0.001). There was no reported major postoperative bleeding related to anticoagulation. All patients were able to resume their anticoagulation or antiplatelet therapy after the surgery.

Conclusion: ESS is a safe procedure when performed in patients receiving anticoagulation or antiplatet therapy, and could be classified as a moderate bleeding risk surgery. Stopping the medication prior to the surgery is mandatory. However, anticoagulation could be resumed early postoperatively because it does not seen to increase the risk for bleeding. Perioperative bridging with heparin should only be dictated by the patient's condition, not by the procedure itself.