Medical Clinics of North America-Periprocedural Antithrombotics: Prophylaxis and Interruption

Med Clin North Am. 2024 Nov;108(6):1017-1037. doi: 10.1016/j.mcna.2024.04.005. Epub 2024 Aug 1.

Abstract

Anticoagulation management in the surgical patient requires clinical expertise and careful attention. For patients already receiving anticoagulation for a defined indication (ie, stroke prevention for atrial fibrillation, treatment of venous thromboembolism (VTE), or presence of a mechanical heart valve), understanding how to manage these agents by weighing the risks of thromboembolic events and bleeding is paramount. Additionally, prevention of VTE in the surgical patient involves the identification of patient-specific and procedure-specific risk factors for both VTE and bleeding. With this information, as well as familiarity with the several antithrombotic options available, an appropriate prophylaxis strategy can be employed.

Keywords: Anticoagulation management; Bleeding risk; Bridging anticoagulation; Periprocedural care; Thromboembolic risk; Venous thromboembolism prophylaxis.

Publication types

  • Review

MeSH terms

  • Anticoagulants* / administration & dosage
  • Anticoagulants* / therapeutic use
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy
  • Fibrinolytic Agents* / therapeutic use
  • Hemorrhage / chemically induced
  • Hemorrhage / prevention & control
  • Humans
  • Perioperative Care / methods
  • Risk Factors
  • Venous Thromboembolism* / prevention & control

Substances

  • Fibrinolytic Agents
  • Anticoagulants