The management of patients who require temporary reversal of vitamin K antagonists for surgery: a practical guide for clinicians.
The management of patients who require temporary interruption of vitamin K antagonists is a common clinical problem, affecting an estimated 400 000 patients per year in Europe and North America. Managing such patients is challenging because of the lack of randomized trials assessing different perioperative anticoagulation management strategies and inconsistent recommendations from consensus groups. Recent non-randomized trials have helped to estimate the risks for arterial thromboembolism and bleeding with bridging anticoagulation involving low-molecular-weight heparin. The objectives of this review are to describe bridging anticoagulation and how it may be used with a short-acting heparin, such as unfractionated heparin or low-molecular-weight heparin, to discuss preoperative patient management, focusing on risk stratification for thromboembolic events and interruption of vitamin K antagonist therapy, and to discuss postoperative patient management, focusing on surgery-related bleeding risk and the resumption of bridging anticoagulation and vitamin K antagonist therapy.
Mannucci
Caterina
C
Department of Medicine, McMaster University and St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Douketis
James D
JD
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D002986:Clinical Trials as Topic; D006470:Hemorrhage / Q000517:prevention & control*; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D013923:Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D006493:Heparin