Management of peri‐operative anti‐thrombotic therapy. (January 2015)

• Record Type: Journal Article
• Authors: van Veen, J. J.; Makris, M.
• Is Part Of: Anaesthesia. Volume 70(2015)Supplement 1
• Page Start: 58
• Page End: e23
• Publication Date: 2015-01
• Subjects: Anesthesia -- Periodicals; 617.96
• DOI: 10.1111/anae.12900
• Languages: English
• ISSNs: 0003-2409

Abstract

Summary: The management of antithrombotic therapy in the peri‐operative setting is a common problem, balancing haemorrhagic risk with continued treatment and thrombotic risk when discontinued. High‐quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. This review discusses the available evidence for the management of patients on warfarin, non‐vitamin K antagonist oral anticoagulant drugs, and antiplatelet therapy in the peri‐operative setting. Bridging therapy for patients on warfarin should be considered for those at highest risk of thrombosis, whereas it may not be necessary for those on non‐vitamin K antagonist oral anticoagulant drugs given the reduced time off anticoagulation and their more predictable pharmacokinetics. Aspirin can be continued for most procedures. Dual antiplatelet agents for patients with a recently inserted coronary artery stent should be continued if possible but decisions should be individualised and taken after multidisciplinary discussion.