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How I Do It: Anticoagulation management for common urologic procedures
Lydia Glick1, Thenappan Chandrasekar, Scott G Hubosky
1Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Insights
Managing antithrombotic medications during urologic surgery requires balancing bleeding and thrombosis risks. This guide offers a systematic approach to perioperative antithrombotic counseling for urologists.
Area of Science:
- Urology
- Cardiology
- Pharmacology
Background:
- Perioperative management of antithrombotic medications is crucial for balancing bleeding and thrombosis risks.
- Recent advancements in antithrombotic therapies have outpaced clear guidelines for their use in urologic surgery.
Purpose of the Study:
- To present a systematic approach to perioperative antithrombotic counseling for urologic procedures.
- To provide guidance on the timing of stopping and restarting anticoagulant and antiplatelet therapy.
Main Methods:
- Developed practice guidelines in consultation with Vascular Medicine service.
- Reviewed current literature on antithrombotic management during urologic surgery.
- Outlined a systematic method for antithrombotic management and multidisciplinary consultation.
Main Results:
- Lack of clear guidelines for managing anticoagulant and antiplatelet therapy during urologic surgery.
- New antithrombotic therapies require careful perioperative management.
- A systematic approach can increase urologist comfort and knowledge.
Conclusions:
- A systematic approach to perioperative antithrombotic management is essential for urologic surgery.
- Multidisciplinary consultation is often necessary for complex cases.
- These guidelines aim to improve patient safety and outcomes by standardizing medication management.
Abstract:
Appropriate perioperative management of antithrombotic medications is critical; for every patient, the risk of bleeding must be balanced against individual risk of thrombosis. There has been a rapid influx of new antithrombotic therapies in the past 5 years, yet there is a lack of clear and concise guidelines on the management of anticoagulant and antiplatelet therapy during urologic surgery. Here we describe our approach to perioperative antithrombotic counseling, including the timing of stopping and restarting these medications. These practice guidelines have been developed in consultation with the Vascular Medicine service at our institution as well as after a review of current literature, and apply to common urologic procedures. Many cases are complex and require medical consultation or a multidisciplinary approach to management. We believe that by presenting our systematic method of antithrombotic management, including when to involve other discplines, we can increase knowledge and comfort amongst urologists in managing these medications in the perioperative period.
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