How I treat anticoagulated patients undergoing an elective procedure or surgery.

Abstract:

:The periprocedural management of patients receiving long-term oral anticoagulant therapy remains a common but difficult clinical problem, with a lack of high-quality evidence to inform best practices. It is a patient's thromboembolic risk that drives the need for an aggressive periprocedural strategy, including the use of heparin bridging therapy, to minimize time off anticoagulant therapy, while the procedural bleed risk determines how and when postprocedural anticoagulant therapy should be resumed. Warfarin should be continued in patients undergoing selected minor procedures, whereas in major procedures that necessitate warfarin interruption, heparin bridging therapy should be considered in patients at high thromboembolic risk and in a minority of patients at moderate risk. Periprocedural data with the novel oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, are emerging, but their relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use. This review aims to provide a practical, clinician-focused approach to periprocedural anticoagulant management.

journal_name

Blood

journal_title

Blood

authors

Spyropoulos AC,Douketis JD

doi

10.1182/blood-2012-06-415943

subject

Has Abstract

pub_date

2012-10-11 00:00:00

pages

2954-62

issue

15

eissn

0006-4971

issn

1528-0020

pii

blood-2012-06-415943

journal_volume

120

pub_type

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