Review article

PERIOPERATIVE MANAGEMENT OF ANTIPLATELET AND ANTICOAGULANT MEDICATION

SVJETLANA DOŠENOVIĆ ; Split University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Care, Split, Croatia
NENAD KARANOVIĆ ; Split University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Care and University of Split, School of Medicine, Split, Croatia

Abstract

Perioperative management of patients receiving anticoagulant and antiplatelet therapy poses a challenge to clinicians who need to balance the increased thromboembolic risk during temporary anticoagulant interruption with the increased risk of bleeding with continuing antithrombotic treatment. An individualized approach to each patient is necessary when making decisions on perioperative anticoagulant and antiplatelet management due to the limited existing evidence base. As a general guideline, it is necessary to interrupt anticoagulation for high bleeding risk procedures. Warfarin, when indicated, should be stopped for 5 days before an elective procedure, and bridging anticoagulation should be considered for patients with a high thromboembolic risk. Direct oral anticoagulants should not be taken for 24 h before low bleeding risk procedures and 48 h before planned higher bleeding risk procedures in individuals with normal renal function (longer with renal
impairment). Aspirin, if used for secondary prevention of cardiovascular disease, can be continued for the majority of invasive non-cardiac procedures, although it can be omitted from 3 days before to 7 days after the procedure if the bleeding risk is high. For low bleeding risk procedures, dual antiplatelet therapy (DAPT) should not be interrupted in patients with a recent acute coronary syndrome or coronary artery stent. Patients on DAPT undergoing high bleeding risk procedures that cannot be delayed during the minimum duration of treatment (4 weeks for a bare metal stent, 12 months for a drug-eluting stent) should continue using aspirin and stop clopidogrel or ticagrelor 5 days before or prasugrel 7 days before planned surgery. Anticoagulant and antiplatelet therapy should be continued in patients undergoing certain minor procedures with minimal bleeding risk (e.g., cataract surgery, dental or minor dermatologic procedures). Postoperative anticoagulant and antiplatelet re-initiation depends primarily on the perceived bleeding risk and adequate hemostasis.

Keywords

anticoagulants; platelet aggregation inhibitors; perioperative; surgical procedures

Hrčak ID:

218948

URI

https://hrcak.srce.hr/218948

Publication date:

4.4.2019.

Article data in other languages: croatian

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