Management of surgical patients receiving anticoagulation and antiplatelet agents.
BACKGROUND
Temporary interruption of long-term anticoagulation and antiplatelet therapy during surgical procedures exposes patients to thrombotic risk. Continuation of these agents, however, is associated with an increased risk of bleeding. Managing anticoagulation can be a particular challenge in the emergency setting.


METHODS
A literature review of published articles sourced using the keywords heparin, warfarin, perioperative, antiplatelet, aspirin and surgery was undertaken. A management plan for all likely situations was developed.


CONCLUSIONS
Based on an individual assessment of risk factors for arterial or venous thromboembolism and the risk of perioperative bleeding, it is possible to form an anticoagulant and antiplatelet management plan likely to achieve a low incidence of bleeding and thrombosis. A multidisciplinary approach is desirable.
Thachil
J
J
Department of Haematology, University of Liverpool, Royal Free Hospital, London, UK. jeckothachil@yahoo.co.uk
Gatt
A
A
Martlew
V
V
D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D004638:Emergency Treatment; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin; D001241:Aspirin