Medline ® Abstract for Reference 2
of 'Perioperative management of patients receiving anticoagulants'
How I treat anticoagulated patients undergoing an elective procedure or surgery.
Spyropoulos AC, Douketis JD
Blood. 2012 Oct;120(15):2954-62. Epub 2012 Aug 28.
The periprocedural management of patients receiving long-term oral anticoagulant therapy remains a common but difficult clinical problem, with a lack of high-quality evidence to inform best practices. It is a patient's thromboembolic risk that drives the need for an aggressive periprocedural strategy, including the use of heparin bridging therapy, to minimize time off anticoagulant therapy, while the procedural bleed risk determines how and when postprocedural anticoagulant therapy should be resumed. Warfarin should be continued in patients undergoing selected minor procedures, whereas in major procedures that necessitate warfarin interruption, heparin bridging therapy should be considered in patients at high thromboembolic risk and in a minority of patients at moderate risk. Periprocedural data with the novel oral anticoagulants, such as dabigatran, rivaroxaban, and apixaban, are emerging, but their relatively short half-life, rapid onset of action, and predictable pharmacokinetics should simplify periprocedural use. This review aims to provide a practical, clinician-focused approach to periprocedural anticoagulant management.
Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, James P. Wilmot Cancer Center, Rochester, NY; and.