Perioperative Management of Anticoagulant Therapy-References

References

Pdf Summary

The provided references encompass extensive research and guidelines on perioperative management of anticoagulant therapy, focusing on balancing thromboembolism prevention with bleeding risk during surgical and invasive procedures. Key themes include management strategies for patients on direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, apixaban, and edoxaban, as well as vitamin K antagonists such as warfarin.<br /><br />Multiple studies and clinical practice guidelines (e.g., from the American College of Chest Physicians, American College of Cardiology, and American Society of Hematology) provide evidence-based recommendations for perioperative anticoagulation management, including when to interrupt therapy, use of bridging with heparin or low-molecular-weight heparin (LMWH), and timing of anticoagulant resumption post-procedure.<br /><br />Considerations for specific clinical scenarios are addressed, such as dental and oral surgery, cardiac device implantation, gastrointestinal endoscopy, neurosurgery, and procedures in patients with mechanical heart valves, atrial fibrillation, or venous thromboembolism (VTE). Studies indicate that routine discontinuation of anticoagulants before minor procedures may not always be necessary and that uninterrupted anticoagulation can be safe in selected cases, reducing thrombotic events without significantly increasing bleeding.<br /><br />Bleeding and thromboembolic risk predictors and patient stratification schemes (e.g., CHA2DS2-VASc for atrial fibrillation stroke risk) are highlighted for perioperative decision-making. The risks and benefits of bridging anticoagulation therapy remain a focus, with meta-analyses and trials (e.g., BRIDGE, PERIOP2) evaluating its efficacy and safety. The importance of individualized dosing, especially in patients with renal impairment, and use of vitamin K or prothrombin complex concentrates to reverse anticoagulation is discussed.<br /><br />Overall, the literature underscores a tailored approach based on procedure bleeding risk, patient thrombotic risk, and anticoagulant pharmacology, aiming to optimize patient outcomes during the perioperative period.

Keywords

perioperative anticoagulation

direct oral anticoagulants

vitamin K antagonists

anticoagulant management guidelines

bridging therapy

thromboembolism prevention

bleeding risk assessment

clinical practice guidelines

patient risk stratification

anticoagulant reversal agents