[Perioperative handling of anticoagulation]

Area of Science:

• Cardiology
• Pharmacology
• Perioperative Medicine

Background:

• Long-term anticoagulation is common for atrial fibrillation (AF) in Germany, using phenprocoumone or novel oral anticoagulants (NOACs).
• Anticoagulant therapy significantly reduces embolic events, especially stroke, by 60% in AF patients.
• Surgical procedures during anticoagulation pose risks of bleeding complications, while cessation increases thromboembolism risk.

Purpose of the Study:

• To evaluate the necessity and risks of perioperative bridging in patients on oral anticoagulants.
• To emphasize individualized risk assessment for managing anticoagulation during surgery.
• To provide guidance on appropriate perioperative anticoagulation management strategies.

Main Methods:

• Review of current practices in managing oral anticoagulation therapy perioperatively.
• Assessment of bleeding risks associated with planned operations.
• Evaluation of individual thromboembolism risk, considering patient age and renal function.

Main Results:

• Perioperative bridging, often with low molecular weight heparin, is indicated when there's a substantial risk of both bleeding (if continued) and thromboembolism (if suspended).
• Bridging therapy itself increases the risk of perioperative bleeding.
• Undifferentiated bridging for all AF patients on anticoagulants is not advised.

Conclusions:

• Individualized risk assessment is crucial for perioperative anticoagulation management.
• Bridging decisions should be based on a patient's specific bleeding and thromboembolism risk profile.
• Avoid routine bridging; tailor management to optimize patient safety during surgery.