• J J van Veen and M Makris.
• Department of Haematology, Sheffield Haemophilia and Thrombosis, Royal Hallamshire Hospital, Sheffield, UK.
• Anaesthesia. 2015 Jan 1; 70 Suppl 1: 58-67, e21-3.

AbstractThe management of antithrombotic therapy in the peri-operative setting is a common problem, balancing haemorrhagic risk with continued treatment and thrombotic risk when discontinued. High-quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. This review discusses the available evidence for the management of patients on warfarin, non-vitamin K antagonist oral anticoagulant drugs, and antiplatelet therapy in the peri-operative setting. Bridging therapy for patients on warfarin should be considered for those at highest risk of thrombosis, whereas it may not be necessary for those on non-vitamin K antagonist oral anticoagulant drugs given the reduced time off anticoagulation and their more predictable pharmacokinetics. Aspirin can be continued for most procedures. Dual antiplatelet agents for patients with a recently inserted coronary artery stent should be continued if possible but decisions should be individualised and taken after multidisciplinary discussion. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

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