Perioperative Management of Antithrombotic Therapy

Douketis, James D.; Spyropoulos, Alex C.; Spencer, Frederick A.; Mayr, Michael; Jaffer, Amir K.; Eckman, Mark H.; Dunn, Andrew; Kunz, Regina

doi:10.1378/chest.11-2298

Cited by 1,430 publications

(542 citation statements)

References 217 publications

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“…Higher dosing decreases the time needed for complete platelet inhibition (15). Platelet regeneration is achieved at a rate of 10-14% with each day of drug interruption (16).…”

Section: Thienopyridines: Clopidogrel Prasugrel Ticagrelormentioning

confidence: 99%

Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

Bárcenas¹,

Aísa²

2016

Rev Esp Enferm Dig

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The development of novel antithrombotic therapy in the past few years and its prescription in patients with cardiovascular and circulatory disease has widened the spectrum of drugs that need to be considered when performing an endoscopic procedure. The balance between the thrombotic risk patients carry due to their medical history and the bleeding risk involved in endoscopic procedures should be thoroughly analyzed by Gastroenterologists. New oral anticoagulants (NOACs) impose an additional task. These agents, that specifically target factor IIa or Xa, do not dispose of an anticoagulation monitoring method nor have an antidote to revert their effect, just as with antiplatelet agents. Understanding the fundamental aspects of these drugs provides the necessary knowledge to determine the ideal period the antithrombotic therapy should be interrupted in order to perform the endoscopic procedure, offering maximum safety for patients and optimal results.

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“…Higher dosing decreases the time needed for complete platelet inhibition (15). Platelet regeneration is achieved at a rate of 10-14% with each day of drug interruption (16).…”

Section: Thienopyridines: Clopidogrel Prasugrel Ticagrelormentioning

confidence: 99%

Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

Bárcenas¹,

Aísa²

2016

Rev Esp Enferm Dig

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“…The first main studies accepted higher levels of anticoagulation 27,28,29,30 , but there is a strong consensus nowadays that the risk of bleeding complications increases disproportionally in patients with INR of 4 or more 3,7,8 .…”

Section: Warfarinmentioning

confidence: 99%

“…It should be remembered however that typical preventive regimens for venous thrombosis exhibit minimal or no efficacy against arterial thromboembolism. The manuscript reviews the vitamin K antagonist Warfarin and the new oral anticoagulants [(NOACs): direct thrombin and factor Xa inhibitors] and is partially based in a number of recently published guidelines from American and European medical societies to which the interested reader is directed for more details 2,3,4,5,6,7,8,9,10 .…”

mentioning

confidence: 99%

“…Using one of these systems in patients with cryptogenic CI, AF episodes of at least 30 seconds were detected 6 times more frequently than in a control group (8.9% vs. 1.4%) after 6 months (12.4% vs. 2% in 12 months) 23 . A table including AF patients and other risk groups for thromboembolic complications has been developed ( Table 2) 7,8 . It can be used in surgical patients, although it is based on annual risk in clinical settings 7 .…”

mentioning

confidence: 99%

“…A table including AF patients and other risk groups for thromboembolic complications has been developed ( Table 2) 7,8 . It can be used in surgical patients, although it is based on annual risk in clinical settings 7 . The risk of hemorrhage in anticoagulated patients can also be reasonably estimated using scales such as HAS-BLED (Table 3) 24, 25 .…”

mentioning

confidence: 99%

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Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

André

2015

Arq. Neuro-Psiquiatr.

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Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

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Noncardiac Surgery in Patients With Coronary Artery Stents

Dweck¹,

Cruden²

2012

Arch Intern Med

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Perioperative Management of Antithrombotic Therapy

Abstract: Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding, and recommended approaches aim to simplify patient management and minimize adverse clinical outcomes.

Cited by 1,430 publications

References 217 publications

Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

Management of antiplatelet and anticoagulant therapy for endoscopic procedures: Introduction to novel oral anticoagulants

Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

Noncardiac Surgery in Patients With Coronary Artery Stents

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