Optimizing Perioperative Anticoagulant Management: Balancing Thromboembolic and Bleeding Risks

Interruption of anticoagulation for a surgical procedure is individualized and based on balancing the risk of perioperative thromboembolism versus the risk of bleeding. Risk assessment for thromboembolism is based on the indication for anticoagulation and a variety of patient-specific factors. Bleeding risk assessment is also largely based on patient factors, such as age and comorbidities, but also the type of procedure being done. The post-operative bleeding risk of surgical procedures can be categorized as high-risk, low-to-moderate-risk, and minimal risk. Each risk category has unique recommendations regarding how long to hold anticoagulation prior to the procedure and when anticoagulation can be safely resumed. Lastly, the type of anticoagulant plays a role in the perioperative strategy based on the duration of action and onset of anticoagulation. Nurses play an important role in risk assessment, patient education, and administration and monitoring of anticoagulants in the perioperative setting.