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Published on: July 31, 2016
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Perioperative management of anticoagulation
Goutham Talari1, Zachary D Demertzis2, Robert D Summey1
1Division of Hospital Medicine, Henry Ford Hospital , Detroit, Michigan, USA.
Hospital Practice (1995)
|July 7, 2020
Summary
Managing anticoagulated patients undergoing procedures involves balancing bleeding and clotting risks. Guidance for holding and resuming anticoagulation, like warfarin or direct oral anticoagulants, relies on patient factors and expert consensus.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Anticoagulated patients require careful management during invasive procedures.
- Balancing thromboembolic and bleeding risks is crucial for periprocedural care.
- Current guidelines often rely on expert consensus for managing anticoagulation.
Purpose of the Study:
- To outline the periprocedural management strategies for patients on anticoagulation.
- To discuss factors influencing anticoagulation management for invasive procedures.
- To highlight the complexity ranging from simple continuation to emergent reversal.
Main Methods:
- Review of clinical trials and management studies.
- Analysis of patient-specific factors for thromboembolic and bleeding risks.
- Discussion of anticoagulant hold and resumption timing.
Main Results:
- Management varies from continuing warfarin for low-risk procedures to holding direct oral anticoagulants for 1-2 days.
- Emergent reversal options include prothrombin complex concentrate, idarucizumab, and andexanet alfa.
- Decision-making is guided by individual thromboembolic and bleeding risk assessments.
Conclusions:
- Periprocedural anticoagulation management requires a tailored approach based on patient risk.
- Expert consensus plays a significant role in current management strategies.
- Further research may refine evidence-based guidelines for anticoagulated patients undergoing procedures.
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