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Published on: July 31, 2016
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[Perioperative management of anticoagulation]
R Eisele1, N Melzer, P Bramlage
1Abteilung Orthopädie, Unfall- und Wiederherstellungschirurgie, Stiftungsklinik Weißenhorn, Kliniken der Kreisspitalstiftung Weißenhorn, Günzburger Str. 41, 89264, Weißenhorn, Deutschland, ralf.eisele@t-online.de.
Summary
Managing long-term oral anticoagulation during surgery remains challenging. While phenprocoumon management is established, direct oral anticoagulant (DOAC) perioperative strategies are controversial due to limited data.
Area of Science:
- Cardiology
- Pharmacology
- Surgical Management
Context:
- Perioperative management of oral anticoagulation is crucial for minimizing bleeding risks during surgical interventions.
- Long-term anticoagulation therapy requires careful consideration during the perioperative period.
Purpose:
- To summarize current data on perioperative anticoagulation management.
- To provide practical recommendations for surgical colleagues.
- To address the challenges in managing patients on oral anticoagulants undergoing surgery.
Summary:
- Perioperative decisions for oral anticoagulation involve assessing bleeding and embolism risks.
- For low bleeding risk, anticoagulation may continue; high-risk procedures require phenprocoumon discontinuation and bridging with heparin.
- Direct oral anticoagulant (DOAC) management is controversial, with varying recommendations on interruption and bridging due to limited clinical experience.
Impact:
- Highlights the ongoing challenges in perioperative anticoagulation management.
- Identifies the need for further research and standardized guidelines for direct oral anticoagulants (DOACs).
- Aims to improve patient safety by informing surgical and medical decision-making.
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