Peri‐operative management of anticoagulation and antiplatelet therapy

Keeling, David; Tait, R. C.; Watson, Henry G.

doi:10.1111/bjh.14344

Cited by 180 publications

(210 citation statements)

References 78 publications

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“…In the context of GI bleeding, warfarin can be interrupted at presentation. It can be simply discontinued for a low-risk haemorrhage and, in addition, reversed in severe haemorrhage, with vitamin K and prothrombin complex concentrate if required 105. Overall, there is a mortality benefit from restarting warfarin once the LGIB has stopped 106–108.…”

Section: Drug Therapy Considerations In Acute Lgibmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

236

241

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This is the first UK national guideline to concentrate on acute lower gastrointestinal bleeding (LGIB) and has been commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). The Guidelines Development Group consisted of representatives from the BSG Endoscopy Committee, the Association of Coloproctology of Great Britain and Ireland, the British Society of Interventional Radiology, the Royal College of Radiologists, NHS Blood and Transplant and a patient representative. A systematic search of the literature was undertaken and the quality of evidence and grading of recommendations appraised according to the GRADE(Grading of Recommendations Assessment, Development and Evaluation) methodology. These guidelines focus on the diagnosis and management of acute LGIB in adults, including methods of risk assessment and interventions to diagnose and treat bleeding (colonoscopy, computed tomography, mesenteric angiography, endoscopic therapy, embolisation and surgery). Recommendations are included on the management of patients who develop LGIB while receiving anticoagulants (including direct oral anticoagulants) or antiplatelet drugs. The appropriate use of blood transfusion is also discussed, including haemoglobin triggers and targets.

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Section: Drug Therapy Considerations In Acute Lgibmentioning

confidence: 99%

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Oakland

Chadwick

East

et al. 2019

Gut

236

241

View full text Add to dashboard Cite

show abstract

“…There are two previously reported cases of haemorrhagic complications of neuraxial puncture in patients on clopidogrel, although in both cases the patients were on multiple antiplatelet agents 41 42. The BSH guidelines state that there is insufficient evidence that they are safe in neuraxial anaesthesia and so advise that clopidogrel, ticagrelor and prasugrel are stopped 7 days before procedures 8. This is in agreement with both American and European anaesthetic guidelines that advise stopping clopidogrel for 7 days before neuraxial anaesthesia due to its irreversible effects on platelet activation, which last for the lifespan of the platelet 3 4 19…”

Section: Antiplateletsmentioning

confidence: 67%

“…A systematic review and a meta-analysis both found no proof for the efficacy of bridging to prevent thromboses, but with increased rates of bleeding 8. In patients with atrial fibrillation, the BRIDGE (Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation) trial showed that no bridging was non-inferior to bridging in terms of arterial thromboembolism (p=0.01), with arterial thromboembolism occurring in 0.4% of the no bridging group, and 0.3% of the bridging group 28.…”

Section: Anticoagulantsmentioning

confidence: 99%

Periprocedural antithrombotic management for lumbar puncture: Association of British Neurologists clinical guideline

Dodd

Emsley²,

Desborough³

et al. 2018

Pract Neurol

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Lumbar puncture (LP) is an important and frequently performed invasive procedure for the diagnosis and management of neurological conditions. There is little in the neurological literature on the topic of periprocedural management of antithrombotics in patients undergoing LP. Current practice is therefore largely extrapolated from guidelines produced by anaesthetic bodies on neuraxial anaesthesia, haematology groups advising on periprocedural management of antiplatelet agents and anticoagulants, and by neuroradiology on imaging-guided spinal procedures. This paper summarises the existing literature on the topic and offers recommendations to guide periprocedural antithrombotic management for LP, based on the consolidation of the best available evidence. .

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“…81 For patients with impaired renal function, it is advised that this interval be prolonged by 24 hours (or longer for dabigatran). 81 Patients undergoing procedures that carry a high bleeding risk should not recommence full dose postoperative anticoagulation until 48-72 hours following the procedure. 81 …”

Section: Perioperative Managementmentioning

confidence: 99%

“…81 Patients undergoing procedures that carry a high bleeding risk should not recommence full dose postoperative anticoagulation until 48-72 hours following the procedure. 81 …”

Section: Perioperative Managementmentioning

confidence: 99%

Drug therapy in anticoagulation: which drug for which patient?

Millar

Laffan

2017

Clinical Medicine

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Four non-vitamin K oral anticoagulants (NOACs) are now licensed and available in the UK, offering unprecedented choices in anticoagulant therapy for clinicians and patients. NOACs have many clear benefi ts over warfarin, the most striking being the reduction in intracranial haemorrhage. However, a number of uncertainties remain: their effi cacy in certain situations, utility of drug assays, signifi cance of drug interactions and management of bleeding. In the absence of any direct comparative trials, it is not clear that any of the NOACs is signifi cantly better than the others in any of the licensed indications. The differential activities, pharmacokinetics, metabolism, excretion and side effects of the agents should be considered when selecting the most appropriate anticoagulant. In this article, we discuss how, with careful selection for the relevant indication, NOACs can simplify therapy while improving outcomes. We aim to provide clinicians with the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. KEYWORDS : Anticoagulant therapy , non-vitamin K oral anticoagulants , NOACs IntroductionThe non-vitamin K oral anticoagulants (NOACs) 1 are now established in UK practice and new members continue to arrive. Within their licensed indications they have clear benefits over warfarin, but a number of uncertainties remain: efficacy in some specific situations, the utility of drug assays, significance of drug interactions and the management of bleeding all suffer from a paucity of data.This article provides an update on developments since the 2014 review in this journal.2 Our aim is to provide the information needed to select the most suitable anticoagulant drug for an individual patient in a given situation. ABSTRACTDrug therapy in anticoagulation: which drug for which patient? Properties of NOACsFour NOACs are now licensed and available in the UK: the direct factor Xa (FXa) inhibitors apixaban, edoxaban and rivaroxaban, and the direct thrombin inhibitor dabigatran. The key to best choice of agent lies in their individual pharmacokinetic profiles, metabolism and routes of excretion.

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Peri‐operative management of anticoagulation and antiplatelet therapy

Abstract: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria are specified in the British Committee for Standards in Haematology (BCSH) guidance pack

Cited by 180 publications

References 78 publications

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology

Periprocedural antithrombotic management for lumbar puncture: Association of British Neurologists clinical guideline

Drug therapy in anticoagulation: which drug for which patient?

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