Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy

Area of Science:

• Anesthesiology
• Pharmacology
• Cardiology

Background:

• Increased prevalence of coronary disease and atrial fibrillation in an aging population has led to wider therapeutic use of anticoagulants.
• Perioperative management of anticoagulated patients is a routine yet complex task for anesthesiologists, requiring careful risk assessment.
• Limited randomized clinical trial data necessitates reliance on clinical judgment for managing antithrombotic therapy during the perioperative period.

Purpose of the Study:

• To review the perioperative management of commonly used outpatient anticoagulants.
• To discuss special considerations for regional anesthesia and interventional pain procedures in anticoagulated patients.
• To provide guidance for anesthesiologists in managing anticoagulation to minimize thromboembolic and hemorrhagic complications.

Main Methods:

• Literature review of commonly used anticoagulants in outpatient settings.
• Discussion of current clinical practices and expert recommendations for perioperative management.
• Analysis of risks and benefits associated with continuing, discontinuing, bridging, or resuming anticoagulation.

Main Results:

• Anticoagulant management requires individualized decisions based on patient-specific factors and procedural risks.
• Specific time points for altering anticoagulation therapy are critical for patient safety.
• Regional anesthesia and interventional pain procedures present unique challenges in anticoagulated patients.

Conclusions:

• Clinical judgment is paramount in the perioperative management of anticoagulated patients.
• Anesthesiologists play a key role in mediating communication and decision-making regarding anticoagulation.
• Further research is needed to establish evidence-based guidelines for perioperative antithrombotic therapy.