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Periprocedural Management of Oral Anticoagulation.
Metadata
Journalmedical clinics of north america3.529Date
2020 May 12
3 months ago
Publication Type
Review
Journal Article
Volume
2020-Jul / 104 : 709-726
Author
Shaw JR 1, Kaplovitch E 2, Douketis J 3
Affiliation
  • 2. Department of Medicine, University Health Network, The University of Toronto, 585 University Avenue, Norman Urquhart Building, 7th Floor, Room 739, Toronto, Ontario M5G 2N2, Canada. Electronic address: https://twitter.com/kaplovitch.
  • 3. Department of Medicine, Division of General Internal Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada; Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L4N 4A6, Canada. Electronic address: [email protected]
Doi
PMIDMESH
Administration, Oral
Anticoagulants
Atrial Fibrillation
Dabigatran
Hemorrhage
Heparin, Low-Molecular-Weight
Humans
Perioperative Care
Postoperative Complications
Pyrazoles
Pyridones
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Rivaroxaban
Stroke
Surgical Procedures, Operative
Warfarin
Abstract
Decisions surrounding periprocedural anticoagulation management must balance thromboembolic and procedural bleed risk. The interruption of both warfarin and DOACs requires consideration of anticoagulant pharmacokinetics, procedural bleed risk and patient characteristics. There is a diminishing role for periprocedural bridging LMWH overall and no role for bridging LMWH for the procedural interruption of DOACs. A clinical approach to perioperative DOAC management based on operative bleeding risk and renal function is safe and effective, and at present, is preferred over preprocedural DOAC levels testing. Clear communication of the anticoagulation interruption plan to both the patient and the patient's care team is essential.
Keywords: Anticoagulants Apixaban Atrial fibrillation Dabigatran Perioperative period Postoperative complications Rivaroxaban Warfarin
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Med Clin North Ammedical clinics of north america
Metadata
LocationUnited States
FromW B SAUNDERS CO-ELSEVIER INC

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