title: [ENT surgery in anticoagulate patients].
abstract: BACKGROUND
  In elective ENT surgery, one frequently sees -patients on oral anticoagulants and platelet inhibitors. While continuation of these therapies increases the risk of bleeding complications, indiscriminate discontinuation can have severe thromboembolic consequences. Furthermore, the number of -anticoagulants and platelet inhibitors in use has increased. The ENT-specialist is regulary confronted with the question of continuation, discontinuation, or bridging of this therapy.
  
  
  METHODS
  Review of the available literature on bleeding complications associated with ENT interventions performed with and without anticoagulants. Overview of the indications for anticoagulants and the different mechansims of action and properties of the different agents. Development of protocols for risk stratification and for perioperative management.
  
  
  CONCLUSIONS
  Patients on oral anticoagulants and platelet inhibitors have significant morbidity and mortality not only due to the underlying diseases, but also due to the perioperative management of these therapies. Perioperative management should be based on well-established treatment guidelines or, in high-risk patients, on multidisciplinary consultation. Even though the recommendations here are evidence-based and cover a multitude of clinical contingencies, they cannot replace clinical decision making, which must consider the specific characteristics and circumstances of the patient, the planned intervention, and the surgical environment.
authors.affiliation: 3. Medizinische Klinik, HELIOS Klinikum Erfurt, Erfurt, Universität Witten/Herdecke.
authors.forename: H
authors.initials: H
authors.lastname: Lapp
authors.affiliation: Angiologie, HELIOS Klinikum Erfurt, Erfurt.
authors.forename: A
authors.initials: A
authors.lastname: Neumeister
authors.affiliation: HNO, HELIOS Klinikum Erfurt, Erfurt.
authors.forename: D
authors.initials: D
authors.lastname: Eßer
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D017558:Elective Surgical Procedures; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D010038:Otorhinolaryngologic Diseases / Q000097:blood* / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000097:blood / Q000209:etiology; D013923:Thromboembolism / Q000097:blood / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors