Thrombosis and coagulation: operative management of the anticoagulated patient

The surgical management of the anticoagulated patient requires an understanding of the fundamentals of blood thrombosis, the mechanisms that enable anticoagulants to work, and the indications for anticoagulation. As percutaneous cardiac and peripheral procedures become increasingly sophisticated, we can expect to encounter more patients on aspirin and clopidogrel. Management strategies will require continued appraisal of available literature for evidence-based surgical practice. This article summarizes how coagulation takes place and explains the role of certain agents that alter coagulation, such as aspirin, clopidogrel, warfarin, heparin and low-molecular-weight heparin. The article also discusses thrombosis risks involving patients with nonvalvular atrial fibrillation, patients with mechanical heart valves and patients with a history of deep vein thrombosis.