Preoperative management of anticoagulation in the surgical

Best Pract Res Clin Anaesthesiol · Jun 2020

Review

Preoperative management of anticoagulation in the surgical patient: Highlights of the latest guidelines.

Oral anticoagulants (OACs) are a class of medications commonly used in the long-term management of patients at risk of thrombosis. They include warfarin and direct oral anticoagulants (DOACs). The aging of the population and improvements in perioperative care have led to an increase in the number of patients on OACs and presenting for different types of elective and emergency surgery. ⋯ It is based on the quantification of a patient's individual hemorrhagic and thrombotic risk together with the intrinsic surgical bleeding risk. We reviewed current guidelines to define effective discontinuation of OACs, the need for bridging with different anticoagulants, and post-surgery OACs re-initiation. We also discussed the option for acute reversal of anticoagulation.

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- Hany Elgamal, Markus M Luedi, Joerg Karl Ender, and Massimiliano Meineri.
- Department of Anaesthesiology, Herzzentrum Leipzig, Leipzig, Germany. Electronic address: hanyreda303@cu.edu.eg.
- Best Pract Res Clin Anaesthesiol. 2020 Jun 1; 34 (2): 141-152.
AbstractOral anticoagulants (OACs) are a class of medications commonly used in the long-term management of patients at risk of thrombosis. They include warfarin and direct oral anticoagulants (DOACs). The aging of the population and improvements in perioperative care have led to an increase in the number of patients on OACs and presenting for different types of elective and emergency surgery. Perioperative management of OACs constitutes a unique challenge. It is based on the quantification of a patient's individual hemorrhagic and thrombotic risk together with the intrinsic surgical bleeding risk. We reviewed current guidelines to define effective discontinuation of OACs, the need for bridging with different anticoagulants, and post-surgery OACs re-initiation. We also discussed the option for acute reversal of anticoagulation.Copyright © 2020 Elsevier Ltd. All rights reserved.

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Preoperative management of anticoagulation in the surgical patient: Highlights of the latest guidelines.

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