Cardiology

Perioperative management of anticoagulant and antiplatelet therapy

Learning objectives

  • To underscore clinical scenarios when anticoagulation interruption is not needed.

  • To explain the how to bridge Coumadin when interruptions are needed.

  • To present a pharmacodynamic strategy to the interruption of direct oral anticoagulants.

  • Introduction

    Long-term oral anticoagulant therapy is often used in patients with atrial fibrillation (AF), a mechanical heart valve (MHV) or venous thromboembolism. The perioperative management of patients who are receiving anticoagulant therapy is already a frequently encountered clinical scenario, likely to increase due to an ageing population. Older people are both more likely to need anticoagulation and to require more surgeries or procedures than younger people. Moreover, anticoagulant use is also increasing due to the availability of the direct oral anticoagulants (DOACs),1 which are easier to administer than vitamin K antagonists (VKA) such as warfarin. Thus, it is estimated that in patients with AF, which…

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