title: [Bridging: Perioperative management of chronic anticoagulation or antiplatelet therapy].
abstract: Oral anticoagulants [Vitamin-K-Antagonists, Dabigatran, Rivaroxaban, Apixaban] or antiplatelet agents [Aspirin, Clopidogrel, Prasugrel, Ticagrelor] are effective in preventing thromboembolic diseases. In case of interventional of surgical procedures patients with indications for chronic anticoagulation [atrial fibrillation, valve prosthesis, venous thromboembolism] or use of antiplatelet agents [cerebrovascular events, cardiovascular events] will require interruption of antithrombotic/antiplatelet therapy with the need of replacement with a short-acting agent. Due to limited data available from randomized studies and meta-analyses the evidence level is low in the majority of recommendations. Therefore for each patient the bleeding and thrombosis risk depending on the individual patient constitution and the planned intervention must be weighted. In patients with an intermediate risk for thrombosis the bleeding risk of the scheduled intervention will influence the bridging recommendation: In patients with a low bleeding risk oral anticoagulation/antiplatelet therapy can be continued or reduced in intensity. In patients with an intermediate or high bleeding risk along with a low thrombosis risk a temporary interruption of the anticoagulation/antiplatelet therapy is feasible. In patients with a high thrombosis and bleeding risk anticoagulation should be bridged with unfractionated heparin [renal insufficiency] or low molecular weight heparin. In the latter risk situation, inhibition of platelet function can be achieved with short-lasting GPIIb-IIIa inhibitors [Eptifibatide, Tirofiban]. Prior to intervention patients treated with the new oral anticoagulants [Dabigatran; Rivaroxaban; Apixaban] are requested to temporary interrupt the anticoagulation depending on the individual drug half-life and their renal function. Bridging therapy with heparin prior to intervention is not necessary with the new oral anticoagulants.
authors.affiliation: Institut für Klinische Chemie, Gerinnungszentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel & Lübeck, Kiel.
authors.forename: U
authors.initials: U
authors.lastname: Nowak-Göttl
authors.affiliation: II. Medizinische Klinik und Poliklinik, Universitätsklinikum Eppendorf, Hamburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Langer
authors.affiliation: Institut für Klinische Chemie, Gerinnungszentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel & Lübeck, Kiel.
authors.forename: V
authors.initials: V
authors.lastname: Limperger
authors.affiliation: Medizinische Klinik A, Universitätsklinikum Münster.
authors.forename: R
authors.initials: R
authors.lastname: Mesters
authors.affiliation: DIAKO, Ev. Diakonie-Krankenhaus, Klinik für Hämatologie und internistische Onkologie, Bremen.
authors.forename: R U
authors.initials: RU
authors.lastname: Trappe
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D057915:Drug Substitution; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D006801:Humans; D008657:Metabolic Clearance Rate / Q000502:physiology; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D018570:Risk Assessment; D013927:Thrombosis / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin