Anesthetic concerns for patients with coagulopathy

Area of Science:

• Pharmacology
• Hematology
• Surgical Medicine

Background:

• Preoperative therapies frequently interfere with patient hemostasis.
• Patients may have underlying hemostatic disorders exacerbated by anticoagulation or antiplatelet agents.
• Pharmacologic agents create acquired hemostatic defects, complicating surgical injury and increasing blood loss.

Purpose of the Study:

• To review the impact of preoperative anticoagulation and antiplatelet therapies on perioperative hemostasis.
• To inform clinicians about the evolving landscape of anticoagulant and antiplatelet agents.
• To highlight the critical need for understanding these agents in patient management.

Main Methods:

• Review of current literature on anticoagulants and antiplatelet agents used preoperatively.
• Identification of common pharmacologic agents impacting hemostasis.
• Analysis of their clinical implications in surgical patients.

Main Results:

• Common agents include low-molecular-weight heparins (LMWHs), fondaparinux, vitamin K antagonists (warfarin), direct Xa inhibitors (rivaroxaban, apixaban), direct thrombin inhibitors (dabigatran, bivalirudin, argatroban), thienopyridines (clopidogrel), and IIb/IIIa receptor antagonists (tirofiban).
• These agents pose significant risks for perioperative bleeding.
• Limited effective methods exist to antagonize their effects.

Conclusions:

• Multiple pharmacologic therapies can affect surgical patients' hemostasis preoperatively.
• Effective reversal strategies for these agents are scarce.
• Prohemostatic pharmacologic approaches and transfusions are often employed to manage bleeding.