Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy.
As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking. Therefore, clinical judgment is typically needed regarding decisions to continue, discontinue, bridge, or resume anticoagulation and regarding the time points when these events should occur in the perioperative period. In this review, we will discuss the most commonly used anticoagulants used in outpatient settings and discuss their management in the perioperative period. Special considerations for regional anesthesia and interventional pain procedures will also be reviewed.
Yale University School of Medicine, New Haven, CT. Electronic address: adriana.oprea@yale.edu.
Adriana D
AD
Oprea
Yale University School of Medicine, New Haven, CT.
Christopher J
CJ
Noto
Yale University School of Medicine, New Haven, CT.
Thomas M
TM
Halaszynski
D000367:Age Factors; D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001777:Blood Coagulation / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000188:drug therapy; D004363:Drug Utilization; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007267:Injections / Q000009:adverse effects; D059408:Pain Management / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013923:Thromboembolism / Q000188:drug therapy*
D000925:Anticoagulants
Anticoagulation; Bridging therapy; Perioperative period