title: Management of peri-operative anti-thrombotic therapy.
abstract: The management of antithrombotic therapy in the peri-operative setting is a common problem, balancing haemorrhagic risk with continued treatment and thrombotic risk when discontinued. High-quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. This review discusses the available evidence for the management of patients on warfarin, non-vitamin K antagonist oral anticoagulant drugs, and antiplatelet therapy in the peri-operative setting. Bridging therapy for patients on warfarin should be considered for those at highest risk of thrombosis, whereas it may not be necessary for those on non-vitamin K antagonist oral anticoagulant drugs given the reduced time off anticoagulation and their more predictable pharmacokinetics. Aspirin can be continued for most procedures. Dual antiplatelet agents for patients with a recently inserted coronary artery stent should be continued if possible but decisions should be individualised and taken after multidisciplinary discussion.
authors.affiliation: Department of Haematology, Sheffield Haemophilia and Thrombosis, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Veen
authors.forename: M
authors.initials: M
authors.lastname: Makris
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D013927:Thrombosis / Q000209:etiology
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors