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 .

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Diseases presenting "high risk" symptom

22q11.2 deletion syndrome

acute rheumatic fever

adrenal incidentaloma

alpha-thalassemia

aniridia

canavan disease

congenital diaphragmatic hernia

congenital toxoplasmosis

cowden syndrome

cushing syndrome

cutaneous mastocytosis

esophageal adenocarcinoma

esophageal carcinoma

esophageal squamous cell carcinoma

fabry disease

harlequin ichthyosis

heparin-induced thrombocytopenia

hirschsprung disease

hodgkin lymphoma, classical

homocystinuria without methylmalonic aciduria

hydrocephalus with stenosis of the aqueduct of sylvius

krabbe disease

legionellosis

liposarcoma

locked-in syndrome

oligodontia

oral submucous fibrosis

papillon-lefèvre syndrome

pendred syndrome

phenylketonuria

primary hyperoxaluria type 1

severe combined immunodeficiency

sneddon syndrome

waldenström macroglobulinemia

werner syndrome

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