Perioperative management of anticoagulation: guidelines translated for the clinician

The perioperative management of patients taking vitamin K antagonists (VKAs) is an evolving area of medicine and poses significant challenges for health care providers. It has been estimated that this issue affects approximately 250,000 patients annually, and the number of patients requiring chronic anticoagulation continues to increase. The lack of evidence, along with the wide variety of clinical scenarios, requires complex decision making on the part of clinicians. In general, when a patient on chronic anticoagulation requires a planned procedure, the clinician must assess the risk of perioperative thrombotic events and the risk of perioperative bleeding complications and weigh those risks in determining the safest perioperative strategy. We aimed to summarize and provide our opinion about the recommendations from the recent 8th edition of the American College of Chest Physicians (ACCP) guidelines for the perioperative management of antithrombotic therapy.