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Perioperative transient ischemic attack caused by the cessation of warfarin.
[locked-in syndrome]
This
paper
describes
the
circumstances
of
a
patient
who
had
been
receiving
long
-term
warfarin
treatment
,
but
ceased
it
prior
to
surgical
operation
,
sustained
a
transient
ischemic
heart
attack
post-operatively
,
which
eventuated
in
delayed
extubation
and
locked-
in
syndrome
.
For
patients
at
low
risk
of
perioperative
bleeding
,
anticoagulation
with
oral
vitamin
K
antagonist
can
probably
be
able
to
maintain
the
therapeutic
range
(
INR
≤
2
.
0
)
extreme
.
For
patients
with
a
high
risk
of
bleeding
,
the
international
normalized
ratio
(
INR
)
should
be
kept
≤
1
.
5
.
Within
this
range
,
patients
at
low
risk
of
thrombosis
can
discontinue
warfarin
treatment
for
2
-
5
days
pre-operatively
;
patients
at
high
risk
for
thrombosis
can
stop
warfarin
but
should
probably
be
treated
with
intravenous
or
subcutaneous
heparin
when
the
INR
is
subtherapeutic
.
Diseases
Validation
Diseases presenting
"long-term warfarin treatment"
symptom
locked-in syndrome
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